Provider Demographics
NPI:1245288562
Name:TEPEDINO, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:TEPEDINO
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 1:1801 N WASHINGTON ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8245
Mailing Address - Country:US
Mailing Address - Phone:931-455-2201
Mailing Address - Fax:931-455-8048
Practice Address - Street 1:1801 N WASHINGTON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8245
Practice Address - Country:US
Practice Address - Phone:931-455-2201
Practice Address - Fax:931-455-8048
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12735208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3180440Medicaid
TN3180440Medicare ID - Type Unspecified
TNB03907Medicare UPIN