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DR. MICHAEL LEE DIMITROFF PH.D.

Clinical Neuropsychologist

Knoxville, Tennessee

Provider NPI: 1790997278

Provider Information:
DR. MICHAEL LEE DIMITROFF PH.D.
Gender: M
Sole Proprietor


Practice Location:
2620 MINERAL SPRINGS AVE SUITE A KNOXVILLE, TN 37917 US
Tel: 865-316-6176  Fax: 865-745-1139

Business Mailing Address:
2620 MINERAL SPRINGS AVE SUITE A KNOXVILLE, TN 37917 US
Tel: 865-316-6176  Fax: 865-745-1139

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
TN2734
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
IN20040111A
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
IL071001991
N103T00000XBehavioral Health & Social Service Providers
Psychologist
IN20040111A
N103TB0200XBehavioral Health & Social Service Providers
Psychologist
TN2734
N103TB0200XBehavioral Health & Social Service Providers
Psychologist
IN20040111A
N103TB0200XBehavioral Health & Social Service Providers
Psychologist
IL071001991
N103TH0004XBehavioral Health & Social Service Providers
Psychologist
TN2734
N103TH0004XBehavioral Health & Social Service Providers
Psychologist
IN20040111A
N103TH0004XBehavioral Health & Social Service Providers
Psychologist
IL071001991
N103TS0200XBehavioral Health & Social Service Providers
Psychologist
TN2734
N103TS0200XBehavioral Health & Social Service Providers
Psychologist
IN20040111A
N103TS0200XBehavioral Health & Social Service Providers
Psychologist
IL071001991
Y103T00000XBehavioral Health & Social Service Providers
Psychologist
TN2734

Other Provider Identifiers:

IssuerNumberStateType
AETNA42902IN01
1511670TN05
BC/BS4210814TN01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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