Healthcare Provider Details

I. General information

NPI: 1114997814
Provider Name (Legal Business Name): MICHAEL S. TANKERSLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1458 W POPLAR AVE STE 205
COLLIERVILLE TN
38017-0631
US

IV. Provider business mailing address

1458 W POPLAR AVE STE 205
COLLIERVILLE TN
38017-0631
US

V. Phone/Fax

Practice location:
  • Phone: 901-335-8966
  • Fax: 901-244-2021
Mailing address:
  • Phone: 901-335-8966
  • Fax: 901-244-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number23880
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number26872
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number26872
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26872
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number26872
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number26872
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License Number26872
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number26872
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number26872
License Number StateTN
# 10
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number26872
License Number StateTN
# 11
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number26872
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: