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General NPI Number Information
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NPI Number | 1134277338
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Entity Type | Organization
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Legal Business Name | MICHAEL D. LITTELL, D.O., PC
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Dates
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Enumeration Date | 01/07/2007
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 700 S BROADWAY
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City | PORTLAND
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State | TN
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Zip | 37148-1625
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Country | US
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Telephone | 615-325-3100
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Fax | 615-325-0076
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Provider Business Mailing Address
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Address Line | 708A N RUSSELL ST
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City | PORTLAND
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State | TN
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Zip | 37148-2073
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Country | US
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Telephone | 615-325-3100
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Fax | 615-325-0076
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL DEAN LITTELL
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Credential | DO
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Telephone | 615-325-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO-711
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License Number State | TN
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