Provider Demographics
NPI:1023078243
Name:MICHAELSON, RICHARD D (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:MICHAELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37116-1069
Mailing Address - Country:US
Mailing Address - Phone:615-868-1266
Mailing Address - Fax:615-868-1316
Practice Address - Street 1:400 N HIGHLAND AVE
Practice Address - Street 2:MIDDLE TN MEDICAL CENTER
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37133
Practice Address - Country:US
Practice Address - Phone:615-396-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18719207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006591OtherBLUE CROSS
TN3032197Medicaid
A99582Medicare UPIN
TN3032197Medicare ID - Type Unspecified
TN3032197Medicaid