Provider Demographics
NPI:1801864012
Name:CAMPBELL, MICHAEL LYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LYLE
Last Name:CAMPBELL
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 1:827 LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802
Mailing Address - Country:US
Mailing Address - Phone:865-984-0900
Mailing Address - Fax:865-984-1035
Practice Address - Street 1:827 LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37802
Practice Address - Country:US
Practice Address - Phone:865-984-0900
Practice Address - Fax:865-984-1035
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35428207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4017788OtherBLUE CROSS BLUE SHIELD
TN200046165OtherRAILROAD MEDICARE
TNTN01A7OtherJOHN DEERE HEALTHCARE
TN3866234Medicaid
TN4017788OtherBLUE CROSS BLUE SHIELD
H46819Medicare UPIN
TN200046165OtherRAILROAD MEDICARE
TNTN01A7OtherJOHN DEERE HEALTHCARE