Provider Demographics
NPI:1710955315
Name:MACKAY, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:MACKAY
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 1:90 VERMONT AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6474
Mailing Address - Country:US
Mailing Address - Phone:865-481-2541
Mailing Address - Fax:865-483-8151
Practice Address - Street 1:90 VERMONT AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6474
Practice Address - Country:US
Practice Address - Phone:865-481-2541
Practice Address - Fax:865-483-8151
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29247207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN200029631OtherRAILROAD MEDICARE
TN3813168Medicaid
TN1469814OtherUNITED HEALTH CARE
TN5415575OtherAETNA
TN100010540OtherTENNCARE
TN3071424OtherBLUE CROSS BLUE SHIELD
TNTN0159OtherJOHN DEERE HEALTHCARE
TNTN0189OtherJOHN DEERE HEALTHCARE
3813167Medicare ID - Type Unspecified
TN103I201872Medicare PIN
TN103I209263Medicare PIN
TN100010540OtherTENNCARE
TNTN0189OtherJOHN DEERE HEALTHCARE