Provider Demographics
NPI:1982672648
Name:MCCOLLUM, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MCCOLLUM
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 1:1600 ACCELERATOR WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3078
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:1600 ACCELERATOR WAY STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3078
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:865-546-9047
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30059207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN200041201OtherRAILROAD MEDICARE
TN3822714Medicaid
TN5249620OtherAETNA
TNTN01B3OtherJOHN DEERE HEALTHCARE
KY6412358100Medicaid
TN4009437OtherBLUE CROSS BLUE SHIELD
TNTN01A5OtherJOHN DEERE HEALTHCARE
TN3822714Medicaid
TNTN01B3OtherJOHN DEERE HEALTHCARE
TN200041201OtherRAILROAD MEDICARE
TN38227131Medicare PIN
3711574Medicare PIN
TNTN01A5OtherJOHN DEERE HEALTHCARE
TN4009437OtherBLUE CROSS BLUE SHIELD
TN103I204504Medicare PIN
TN38227113Medicare PIN