MEDICARE: MICHAEL D. LITTELL, D.O., PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO-711	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134277338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D. LITTELL, D.O., PC

Provider Business Mailing Address
First Line	:	708A N RUSSELL ST
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-2073
Country	:	US
Telephone Number	:	615-325-3100
Fax Number	:	615-325-0076

Provider Business Practice Location Address
First Line	:	700 S BROADWAY
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-1625
Country	:	US
Telephone Number	:	615-325-3100
Fax Number	:	615-325-0076

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL DEAN LITTELL
Credential	:	DO
Telephone Number	:	615-325-3100

Provider Enumeration Date	:	01/07/2007
Last Update Date	:	04/04/2008

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