Provider Demographics
NPI:1104141472
Name:KITSON, MICHELLE DAWN (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:KITSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KITSON
Other - Last Name:STANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-9800
Mailing Address - Fax:901-516-9817
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-516-9800
Practice Address - Fax:901-516-9817
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD48535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4354837OtherBCBS TN
TN1529576Medicaid
TN103I111198Medicare PIN