Provider Demographics
NPI:1215964911
Name:FLEENOR, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:FLEENOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:260 MIDWAY MEDICAL PARK
Mailing Address - Street 2:STE 100
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1721
Mailing Address - Country:US
Mailing Address - Phone:423-968-4446
Mailing Address - Fax:423-968-4802
Practice Address - Street 1:260 MIDWAY MEDICAL PARK
Practice Address - Street 2:STE 100
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1721
Practice Address - Country:US
Practice Address - Phone:423-968-4446
Practice Address - Fax:423-968-4802
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18558207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3048090Medicaid
VA006404774Medicaid
TN3048090Medicaid
TN200025568Medicare PIN
TN3048093Medicare PIN