Basic Information
| Provider Information | |||||||||
| NPI: | 1477658656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROWELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK BLVD | ||||||||
| Address2: | 250 WEST | ||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376207430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238446620 | ||||||||
| FaxNumber: | 4238446627 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK BLVD | ||||||||
| Address2: | 250 WEST | ||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376207430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238446620 | ||||||||
| FaxNumber: | 4238446627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 21585 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | F03906748 | 01 | TN | CHAMPUS GROUP | OTHER | 7366345 | 05 | VA | MEDICAID | 770001281 | 01 | TN | MCRAILROAD/GROUP #CA8128 | OTHER | 064486 | 01 | TN | INDIV ANTHEM/GROUP#093410 | OTHER | TN0103 | 01 | TN | JOHN DEERE NOW UNITED HC | OTHER | 0126098 | 01 | TN | BCBS OF TENNESSEE | OTHER | 022276800 | 01 | TN | BLACK LUNG GROUP | OTHER | 0636398 | 01 | TN | UMWA GROUP | OTHER | 3063419 | 05 | TN | MEDICAID | 4545625 | 01 | TN | AETNA | OTHER |