Provider Demographics
NPI:1780774083
Name:CZARNECKI, MICHAEL TODD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
Last Name:CZARNECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8308
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-0308
Mailing Address - Country:US
Mailing Address - Phone:423-710-3864
Mailing Address - Fax:423-710-3865
Practice Address - Street 1:1301 MCCALLIE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2934
Practice Address - Country:US
Practice Address - Phone:423-710-3864
Practice Address - Fax:423-710-3865
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2011-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM4016207R00000X, 207RC0200X, 207RP1001X, 207RS0012X, 208D00000X
TN44980207RP1001X, 207RC0200X, 207RS0012X, 207R00000X, 208D00000X
GA063058207RP1001X, 207RC0200X, 207RS0012X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I704006Medicare PIN