Healthcare Provider Details

I. General information

NPI: 1275993420
Provider Name (Legal Business Name): ES PEDIATRIC PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MARINA DR
GEORGETOWN SC
29440-2410
US

IV. Provider business mailing address

435 MARINA DR
GEORGETOWN SC
29440-2410
US

V. Phone/Fax

Practice location:
  • Phone: 843-833-8595
  • Fax: 843-833-8599
Mailing address:
  • Phone: 843-833-8595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34585
License Number StateSC

VIII. Authorized Official

Name: DR. MICHELLE MARIE STEFFEN
Title or Position: OWNER
Credential: M.D.
Phone: 843-833-8595