Provider Demographics
NPI:1134150527
Name:BEHREND, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BEHREND
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 1:991 NORFOLK GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8223
Mailing Address - Country:US
Mailing Address - Phone:423-903-4092
Mailing Address - Fax:
Practice Address - Street 1:991 NORFOLK GREEN CIR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8223
Practice Address - Country:US
Practice Address - Phone:423-903-4092
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25623207Q00000X
UT6065319-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA412152207AMedicaid
TN30831810OtherMEDICARE PTAN
GA52231256OtherBCBS
GA511I720001OtherUS DEPT. OF LABOR WC
UT005734311Medicare ID - Type Unspecified
GA511I720001OtherUS DEPT. OF LABOR WC
UTB65600Medicare UPIN