Healthcare Provider Details

I. General information

NPI: 1164675559
Provider Name (Legal Business Name): MICHAEL PHILIP GREENBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W FARIS RD
GREENVILLE SC
29605-4255
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7070
  • Fax: 864-454-4669
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35636
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: