Healthcare Provider Details

I. General information

NPI: 1770566176
Provider Name (Legal Business Name): MICHAEL L MAGGART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BLOUNT AVE SUITE 800
KNOXVILLE TN
37920-1632
US

IV. Provider business mailing address

101 E BLOUNT AVE SUITE 800
KNOXVILLE TN
37920-1632
US

V. Phone/Fax

Practice location:
  • Phone: 865-632-5900
  • Fax: 865-637-2114
Mailing address:
  • Phone: 865-632-5900
  • Fax: 865-637-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD0000014758
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: