Healthcare Provider Details

I. General information

NPI: 1245346196
Provider Name (Legal Business Name): MICHAEL J BYKOWSKY MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHLAND MEDICAL PARK DR STE 200 CAROLINA ALLERGY AND ASTHMA CONSULTANTS
COLUMBIA SC
29203-6830
US

IV. Provider business mailing address

1 RICHLAND MEDICAL PARK DR STE 200 CAROLINA ALLERGY AND ASTHMA CONSULTANTS
COLUMBIA SC
29203-6830
US

V. Phone/Fax

Practice location:
  • Phone: 803-765-9233
  • Fax: 803-779-0344
Mailing address:
  • Phone: 803-765-9233
  • Fax: 803-779-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number17903
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: