MEDICARE: DR. MICHAEL THOMAS MYSZKA PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0100X	Health Service Psychologist	1179	TN

General Provider Information

NPI Number	:	1104959501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THOMAS MYSZKA PH.D.

Provider Business Mailing Address
First Line	:	4211 ELKINS AVENUE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209
Country	:	US
Telephone Number	:	615-298-4193
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 ELKINS AVE
Second Line	:	A
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3641
Country	:	US
Telephone Number	:	615-298-4193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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