Healthcare Provider Details

I. General information

NPI: 1184875627
Provider Name (Legal Business Name): MICHAEL PATRICK MADIGAN D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CAPITAL DR
KNOXVILLE TN
37922-3393
US

IV. Provider business mailing address

117 CAPITAL DR
KNOXVILLE TN
37922-3393
US

V. Phone/Fax

Practice location:
  • Phone: 865-670-7477
  • Fax:
Mailing address:
  • Phone: 865-670-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS00000091
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: