Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Michael Itidiare, DO, MBS

Individual provider Gastroenterology Physician · NPI 1316388556

Dr. Michael Itidiare, DO, MBS is a Gastroenterology in Kingsport, Tennessee. Qualified in 2013, 13 years ago. Practices with Capital Health Medical Group, a 438-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in New Jersey, Tennessee and Virginia.

Years since qualifying
13
Licensed in
NJ, TN, VA
In the registry since
2013
Specialties on file
5
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone: (423) 224-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1 Capital Way, Pennington, NJ 08534-2520 — (609) 303-4000
  • 1 Medical Park Blvd, Bristol, TN 37620-7430 — (423) 844-1121

Specialties & licences

Gastroenterology Physician (primary) Taxonomy 207RG0100X · Licence 25MB10130600 (NJ)
Internal Medicine Physician Taxonomy 207R00000X · Licence 6450 (TN)
Internal Medicine Physician Taxonomy 207R00000X · Licence 0102208235 (VA)
Gastroenterology Physician Taxonomy 207RG0100X · Licence 6450 (TN)
Gastroenterology Physician Taxonomy 207RG0100X · Licence 0102208235 (VA)

Record details

NPI number1316388556
Entity typeIndividual (Type 1)
GenderMale
Credentials DO , MBS
Sole proprietorYes
NPI enumeratedJuly 16, 2013
Last updated in NPPESFebruary 25, 2026
Certification dateFebruary 25, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGASTROENTEROLOGY
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Capital Health Medical Group — 438 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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