Provider Demographics
NPI:1457389967
Name:THOMAS, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:356 24TH AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1514
Mailing Address - Country:US
Mailing Address - Phone:615-292-5722
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:3901 CENTRAL PIKE
Practice Address - Street 2:SUITE 555
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3419
Practice Address - Country:US
Practice Address - Phone:615-874-9667
Practice Address - Fax:615-871-9682
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN13976MD208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
621278261OtherTN CARE SELECT
621278261OtherFIRST HEALTH
TN3020078Medicaid
TN62127826137076A001OtherTRICARE
021101458OtherMEDICARE RR
TN125537291831OtherHUMANA
1740238OtherUNITED HEALTHCARE
0056839OtherBCBS
TN007930OtherHEALTHSPRING
TN6212782610002OtherCIGNA
621278261OtherBEECH ST
681009OtherAETNA
0056839OtherBCBS
621278261OtherBEECH ST