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General NPI Number Information
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NPI Number | 1396130613
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Entity Type | Individual
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Provider Name | MICHAEL GLENN DOMINA D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 740 MIDDLE CREEK RD STE 200
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City | SEVIERVILLE
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State | TN
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Zip | 37862-5056
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Country | US
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Telephone | 865-908-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 303 SOUTH TULANE AVENUE 5303
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City | OAK RIDGE
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State | TN
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Zip | 37830
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | DO213625
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | DO3503
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | LT22012
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 1630
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License Number State | NE
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5095
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License Number State | TN
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