Revelle, Michael Allen

Revelle, Michael Allen is an individual health care provider with primary practice located at 708 W Forest Ave , Jackson TN 38301-3901. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Revelle, Michael Allen can be contacted via phone (731) 660-8759.

Contact Information

Primary practice address
708 W Forest Ave Jackson TN 38301-3901
Phone: (731) 660-8759
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD34579 Tennessee

Profile Details

NPI number 1295714558
LBN Legal business name Revelle, Michael Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 13th, 2006
Last updated Jul 16th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295714558 NPPES
Other P00109858 RR MEDICARE
MEDICAID 3861019 RR MEDICARE
Other 4032737 RR MEDICARE

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