Basic Information
| Provider Information | |||||||||
| NPI: | 1356318661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THRELKELD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6799 GREAT OAKS RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381382584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016853490 | ||||||||
| FaxNumber: | 9016853499 | ||||||||
| Practice Location | |||||||||
| Address1: | 6029 WALNUT GROVE RD STE C002 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016853490 | ||||||||
| FaxNumber: | 9016853499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2006 | ||||||||
| LastUpdateDate: | 01/02/2019 | ||||||||
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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 | 207RI0200X | MD15116 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 155434001 | 05 | AR | MEDICAID | 00017990 | 05 | MS | MEDICAID | 3721649 | 05 | TN | MEDICAID | 3042007 | 05 | TN | MEDICAID |