Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 13958 | SC |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 13958 | SC |
NPI | 1669439766 |
---|---|
Provider Name | Dr. Michael E. Tollison |
First Address | Greenville, SC 29615-4816 |
Second Address | Greenville, SC 29615-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 10/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139585 | (05) | SC |
8157 | MEDICARE PTAN (01) | SC |
F33134 | (02) | SC |