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NPI Code Detail

MEDICARE: MICHAEL A. STIPANOV MD

MEDICARE: MICHAEL A. STIPANOV MD
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
1207RH0003XHematology & Oncology PhysicianMD26565TN
2207RH0003XHematology & Oncology Physician047026GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255384616
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL A. STIPANOV MD
Provider Business Mailing Address
First Line : PO BOX 440100
Second Line :
City : NASHVILLE
State : TN
Zip : 37244-0100
Country : US
Telephone Number : 423-698-1844
Fax Number : 423-624-2226
Provider Business Practice Location Address
First Line : 605 GLENWOOD DR
Second Line : SUITE 200
City : CHATTANOOGA
State : TN
Zip : 37404-1130
Country : US
Telephone Number : 423-698-1844
Fax Number : 423-624-2226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 02/26/2013

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