Individual
MR. MICHAEL C ELLIS
Active
Individual
MR. MICHAEL C ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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