Provider Demographics
NPI:1962426890
Name:BARON, MICHAEL JOHN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BARON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 PINEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NUNNELLY
Mailing Address - State:TN
Mailing Address - Zip Code:37137-2523
Mailing Address - Country:US
Mailing Address - Phone:931-729-9728
Mailing Address - Fax:931-729-7272
Practice Address - Street 1:6107 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:NUNNELLY
Practice Address - State:TN
Practice Address - Zip Code:37137-2523
Practice Address - Country:US
Practice Address - Phone:931-729-9728
Practice Address - Fax:931-729-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD213392084A0401X
LAMD.0187362084A0401X
MOR6G182084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3883046Medicaid
TN3883046Medicare PIN
TN3883046Medicaid