Healthcare Provider Details

I. General information

NPI: 1114934676
Provider Name (Legal Business Name): MICHAEL TIMOTHY MCCORMACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ALCOA HWY SUITE E-210
KNOXVILLE TN
37920-2244
US

IV. Provider business mailing address

1940 ALCOA HWY SUITE E-210
KNOXVILLE TN
37920-2244
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-7471
  • Fax: 865-305-6563
Mailing address:
  • Phone: 865-524-7471
  • Fax: 865-305-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number27183
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: