Individual
MR. MICHAEL C ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3024 BUSINESS PARK CIR, GOODLETTSVILLE, TN 37072-3132
(615) 851-6033
(615) 851-2018
Mailing address
3024 BUSINESS PARK CIR, GOODLETTSVILLE, TN 37072-3132
(615) 851-6033
(615) 851-2018
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD11612
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1509264
MEDICAID - MTI
TN
05
—
1509264
—
TN
01
—
300108651
RAILROAD MEDICARE
TN
01
—
3031462
BCBS
TN
05
—
3035616
—
TN
01
—
3135920
BCBS
TN
01
—
4200345
BCBS TN
TN
01
—
4291338
BCBS - MTI
TN
01
—
64918170
TRICARE
TN
05
—
64918170
—
KY
Enumeration date
06/05/2006
Last updated
11/30/2011
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