Healthcare Provider Details

I. General information

NPI: 1013574839
Provider Name (Legal Business Name): TARIK MUJADZIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLASTIC SURGERY 2 MEDICAL PARK, STE 300
COLUMBIA SC
29203
US

IV. Provider business mailing address

PLASTIC SURGERY 2 MEDICAL PARK, STE 300
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-545-5800
  • Fax: 803-928-0492
Mailing address:
  • Phone: 803-545-5800
  • Fax: 803-928-0492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberLL82570
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: