Healthcare Provider Details

I. General information

NPI: 1447254370
Provider Name (Legal Business Name): MICHAEL TAITE SEALS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARK WEST BLVD
KNOXVILLE TN
37923-4200
US

IV. Provider business mailing address

PO BOX 31547
KNOXVILLE TN
37930-1547
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-6065
  • Fax: 865-531-6325
Mailing address:
  • Phone: 865-693-6065
  • Fax: 865-531-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number18915
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: