Itidiare, Michael

Itidiare, Michael is an sole proprietor health care provider with primary practice located at 130 W Ravine Rd , Kingsport TN 37660-3837. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gastroenterology, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Gastroenterology is his primary health care specialty. Itidiare, Michael can be contacted via phone (423) 224-4000.

Contact Information

Primary practice address
130 W Ravine Rd Kingsport TN 37660-3837
Phone: (423) 224-4000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 25MB10130600 New Jersey
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 6450 Tennessee
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 0102208235 Virginia
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 6450 Tennessee
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 0102208235 Virginia

Profile Details

NPI number 1316388556
LBN Legal business name Itidiare, Michael
Credentials D.O., M.B.S
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 16th, 2013
Last updated Feb 25th, 2026 - about 9 months 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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