Provider Demographics
NPI:1427040021
Name:DIAZ, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:DIAZ
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 1:105 GLEN OAK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6424
Mailing Address - Country:US
Mailing Address - Phone:615-822-6716
Mailing Address - Fax:615-822-9805
Practice Address - Street 1:105 GLEN OAK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6424
Practice Address - Country:US
Practice Address - Phone:615-822-6716
Practice Address - Fax:615-822-9805
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16303207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3014073Medicaid
TN3014073Medicare ID - Type Unspecified
TNA97810Medicare UPIN