Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301056114 | MI |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 26861 | TN |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD34310 | SC |
NPI | 1750329819 |
---|---|
Provider Name | Michael Jonathan Mendelow |
First Address | Greenville, SC 29605-4255 |
Second Address | Greenville, SC 29605-4255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 26/03/2014 |