Provider Demographics
NPI:1477539542
Name:KAUZLARICH, MICHAEL P (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:KAUZLARICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 CLINCHFIELD STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3606
Mailing Address - Country:US
Mailing Address - Phone:423-230-2700
Mailing Address - Fax:423-230-2710
Practice Address - Street 1:444 CLINCHFIELD ST STE 2700
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3858
Practice Address - Country:US
Practice Address - Phone:423-230-2700
Practice Address - Fax:423-230-2710
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1438207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4274358OtherBLUE CROSS BLUE SHIELD
VA010312922Medicaid
TN1508895Medicaid
TN1508895Medicaid
TN4157347OtherBLUE CROSS BLUE SHIELD GROUP
TN3706151OtherMEDICARE GROUP
VA010312922Medicaid