Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 22838 | SC |
N | 207ND0900X | Dermatopathologist | 22838 | SC |
N | 207NP0225X | Pediatric Dermatologist | 22838 | SC |
NPI | 1790736312 |
---|---|
Provider Name | Dr. Michele A Mittelbronn |
First Address | Mt Pleasant, SC 29464-5427 |
Second Address | Mt Pleasant, SC 29464-5427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 22/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200070804 | TAX ID (01) | SC |
H49582 | (02) | SC |