Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 22908 | SC |
NPI | 1003857947 |
---|---|
Provider Name | Michael James Poinsette |
First Address | Greenville, SC 29615-4545 |
Second Address | Greenville, SC 29615-6138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 22/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
229087 | (05) | SC |
4919156 | CIGNA ID (01) | SC |
571004971018 | BCBS OF SC ID (01) | SC |
7335397 | AETNA ID (01) | SC |
80185868 | RR MEDICARE (01) | SC |
H60202 | (02) | SC |