Basic Information
| Provider Information | |||||||||
| NPI: | 1265847040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAUVAGEAU | ||||||||
| FirstName: | MITCHEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 WOODMONT BLVD STE LL50 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024996252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4230 HARDING PIKE STE 400 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372054900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153869089 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0123X | 5101021207 | MI | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YS0123X | 3681 | TN | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
No ID Information.