MEDICARE: RONALD MICHAEL M.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	207RG0100X	Gastroenterology Physician	21690	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01003586	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4308326	OTHER	TN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710915061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD MICHAEL M.D.

Provider Business Mailing Address
First Line	:	1211 UNION AVE STE 330
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3725 CHAMPION HILLS DR STE 2400
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8000
Country	:	US
Telephone Number	:	901-367-9001
Fax Number	:	901-565-8787

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	04/29/2024

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Directions to “ RONALD MICHAEL M.D.” Practice Location

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