Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | LL38204 | SC |
NPI | 1003298647 |
---|---|
Provider Name | Kelsey Klostermeyer Mcdill |
First Address | Columbia, SC 29229-4341 |
Second Address | Blythewood, SC 29016-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 11/07/2019 |