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Search › Tennessee › 207RG0100X

Michael Itidiare, D.O., M.B.S

NPI 1316388556 · on the registry since 2013 · sole proprietor

Practice

Address
130 W Ravine Rd
Kingsport, TN 37660
Phone
(423) 224-4000
Organisation at this address
Walgreen Co
Id Micro Pllc
Wps Providers Inc
Kingsport Consultants
Wellmont Health System
Inferred from a shared address, not stated in the registry.
Clinicians at this address
198

Additional practice sites

  • 1 Capital Way, Pennington, NJ
  • 1 Medical Park Blvd, Bristol, TN

Registry record

Primary taxonomy
207RG0100X
207RG0100X
Also registered as
207R00000X
207R00000X
207RG0100X
207RG0100X
Licence states on file
NJ, TN, VA
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2026-02-25

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Tennessee