MEDICARE: MICHAEL H HARTSELL MD

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	12522	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00351983	OTHER	TN	RR MEDICARE PIN

General Provider Information

NPI Number	:	1902842537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL H HARTSELL MD

Provider Business Mailing Address
First Line	:	1225 E WEISGARBER RD
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2604
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 TUSCULUM BLVD STE 3000
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-4648
Country	:	US
Telephone Number	:	423-638-1188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	10/03/2018

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