Provider Demographics
NPI:1134277338
Name:MICHAEL D. LITTELL, D.O., PC
Entity type:Organization
Organization Name:MICHAEL D. LITTELL, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LITTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-325-3100
Mailing Address - Street 1:708A N RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-2073
Mailing Address - Country:US
Mailing Address - Phone:615-325-3100
Mailing Address - Fax:615-325-0076
Practice Address - Street 1:700 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1625
Practice Address - Country:US
Practice Address - Phone:615-325-3100
Practice Address - Fax:615-325-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO-711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730504Medicaid
TNB04903Medicare UPIN
TN3730504Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER