Healthcare Provider Details

I. General information

NPI: 1114984010
Provider Name (Legal Business Name): MICHAEL R CAUDLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 WESTERN AVE
KNOXVILLE TN
37921-5718
US

IV. Provider business mailing address

6350 W A J HWY DEPARTMENT 100
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-0406
  • Fax: 865-544-0480
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14502
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number14502
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: