Provider Demographics
NPI:1134153703
Name:BUGG, MICHAEL FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:BUGG
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 1:7550 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1745
Mailing Address - Country:US
Mailing Address - Phone:901-542-6801
Mailing Address - Fax:901-542-6871
Practice Address - Street 1:7550 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1745
Practice Address - Country:US
Practice Address - Phone:901-542-6801
Practice Address - Fax:901-542-6871
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000023860207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123430001OtherMEDICAID
MO203696604OtherMEDICAID
AR96809OtherBLUE CROSS OF ARKANSAS
220024507OtherRAIL ROAD MEDICARE
TN3075050Medicaid
TN3031619OtherBLUE CARE
TN000000004128OtherMEMPHIS MANAGED CARE
MS0112796OtherMEDICAID
TN3031619OtherBLUE CROSS BLUE SHIELD TN
MO203696604OtherMEDICAID
TN3031619OtherBLUE CROSS BLUE SHIELD TN