Provider Demographics
NPI:1376594291
Name:DILLARD, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:DILLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 DR. MARTIN LUTHER KING BLVD.
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813
Mailing Address - Country:US
Mailing Address - Phone:423-587-1987
Mailing Address - Fax:423-587-9252
Practice Address - Street 1:220 DR. MARTIN LUTHER KING BLVD.
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-587-1987
Practice Address - Fax:423-587-9252
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29980207YS0012X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1504499Medicaid
TN1506042Medicaid
TN3828476Medicaid
TN38284771Medicare PIN
TN1506042Medicaid
38284761Medicare PIN
TN103I42944Medicare PIN
TN3707881Medicare PIN
F98121Medicare UPIN