Healthcare Provider Details

I. General information

NPI: 1669406575
Provider Name (Legal Business Name): WILLIAM S KANICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 HENRY TECKLENBURG DRIVE
CHARLESTON SC
29414-5734
US

IV. Provider business mailing address

PO BOX 10760
WESTMINSTER CA
92685-0760
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-1000
  • Fax:
Mailing address:
  • Phone: 800-396-3437
  • Fax: 562-468-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23286
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: