Basic Information
| Provider Information | |||||||||
| NPI: | 1023016631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ROGER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 NEW YORK AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378305212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658355400 | ||||||||
| FaxNumber: | 8658355401 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 NEW YORK AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378305212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658355400 | ||||||||
| FaxNumber: | 8658355401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD026356 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3719998 | 05 | TN | MEDICAID |