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NPI Code Detail

MEDICARE: MICHAEL JOSE BLANCO M.D.

MEDICARE: MICHAEL JOSE BLANCO M.D.
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
1208M00000XHospitalist Physician60754TN
2207RG0100XGastroenterology Physician60754TN

General Provider Information

NPI Number : 1508284456
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JOSE BLANCO M.D.
Provider Business Mailing Address
First Line : 2020 EXETER RD
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-3945
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 740 COOL SPRINGS BLVD STE 140
Second Line :
City : FRANKLIN
State : TN
Zip : 37067-6449
Country : US
Telephone Number : 615-771-8786
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2014
Last Update Date : 06/23/2022

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