MEDICARE: MICHAEL A TODD MD PA

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	07937	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DO1309	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	415742199	OTHER	MS	BLUE CROSS

General Provider Information

NPI Number	:	1134102189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL A TODD MD PA

Provider Business Mailing Address
First Line	:	PO BOX 664
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-0664
Country	:	US
Telephone Number	:	662-538-2174
Fax Number	:	662-538-2139

Provider Business Practice Location Address
First Line	:	200 HWY 30 W
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3112
Country	:	US
Telephone Number	:	662-538-2174
Fax Number	:	662-538-2139

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. MICHAEL A TODD
Credential	:	M.D.
Telephone Number	:	662-538-2174

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	04/07/2009

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Directions to “MICHAEL A TODD MD PA ” Practice Location

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