Provider Demographics
NPI:1811933674
Name:COLLIER, MICHAEL SHAWN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
Last Name:COLLIER
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 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200N
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:
Practice Address - Street 1:11808 KINGSTON PIKE
Practice Address - Street 2:SUITE 160
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3803
Practice Address - Country:US
Practice Address - Phone:865-966-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3851843Medicaid
TN110205243OtherRR MEDICARE
TN3851843Medicare ID - Type UnspecifiedLEGACY PIN
H13571Medicare UPIN
TN3851843Medicaid