Healthcare Provider Details

I. General information

NPI: 1164004933
Provider Name (Legal Business Name): BRIAN MICHAEL FAGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 MEDICAL CENTER DR
NASHVILLE TN
37232-2730
US

IV. Provider business mailing address

1161 21ST AVE S CCC-4322 MCN
NASHVILLE TN
37232-2730
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-6642
  • Fax: 615-322-0689
Mailing address:
  • Phone: 615-343-6642
  • Fax: 615-322-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: