Healthcare Provider Details

I. General information

NPI: 1134681935
Provider Name (Legal Business Name): MIKI LINDSEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FOREST DR STE 400
COLUMBIA SC
29204-4057
US

IV. Provider business mailing address

3008 BRATTON ST
COLUMBIA SC
29205-1315
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-7316
  • Fax:
Mailing address:
  • Phone: 870-299-0695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number92152
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: