Individual provider Active NPI

Michael R Liske, MD

  • Pediatric Cardiology Physician
  • Knoxville, TN
National Provider Identifier
1013091123
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
MD31697 Issued in TN
Practice address
2018 Clinch Avenue South Tower 2ND Floor
Knoxville, TN 37916
Phone
(865) 522-0420
Fax
(865) 246-7564
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X MD31697 TN Primary

Addresses

Primary practice location

2018 Clinch Avenue South Tower 2ND Floor
Knoxville, TN 37916

Mailing address

PO Box 50068
Knoxville, TN 37950-0068
Phone (865) 541-8895

Other identifiers 2

IdentifierTypeStateIssuer
1514668MedicaidTN
64013873MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141111002292 TN Practitioner - Pediatric Medicine 7113075623 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD31697TNMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Tennessee Pediatric Cardiology, P.C. Pediatric Cardiology CurrentSince Aug 25, 2014 Accepting new patients
East Tennessee Children'S Hospital Association, Inc. Past Accepting new patients

Locations

2001 Highland Ave
#B
Knoxville, TN 37916
Phone (865) 771-9070

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1013091123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50068",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379500068",
            "telephone_number": "865-541-8895",
            "fax_number": "865-633-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 CLINCH AVENUE SOUTH TOWER 2ND FLOOR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "37916",
            "telephone_number": "865-522-0420",
            "fax_number": "865-246-7564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISKE",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "TN",
            "license": "MD31697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1514668",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64013873",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.