Healthcare Provider Details

I. General information

NPI: 1851329031
Provider Name (Legal Business Name): MICHAEL ROBERT TORKELSON M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PROGRESSIVE ST
BLUFFTON SC
29910-5165
US

IV. Provider business mailing address

509 JETFIRE PT
BLUFFTON SC
29910-5346
US

V. Phone/Fax

Practice location:
  • Phone: 843-548-0533
  • Fax: 843-815-9121
Mailing address:
  • Phone: 540-532-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21667
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: