Healthcare Provider Details

I. General information

NPI: 1750479598
Provider Name (Legal Business Name): MICHAEL J OBOYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 PATEWOOD DR SUITE 200
GREENVILLE SC
29615-3589
US

IV. Provider business mailing address

209 PATEWOOD DR STE. 200
GREENVILLE SC
29615-3581
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-9900
  • Fax: 864-234-9090
Mailing address:
  • Phone: 864-234-9900
  • Fax: 864-234-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19958
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: