Healthcare Provider Details

I. General information

NPI: 1447442835
Provider Name (Legal Business Name): MICHELE L SPERO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 S LAKE DR
LEXINGTON SC
29072-3432
US

IV. Provider business mailing address

PO BOX 1798
LEXINGTON SC
29071-1798
US

V. Phone/Fax

Practice location:
  • Phone: 803-957-8000
  • Fax: 803-957-9025
Mailing address:
  • Phone: 803-957-8000
  • Fax: 803-957-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13101
License Number StateSC

VIII. Authorized Official

Name: DR. MICHELE L SPERO
Title or Position: OWNER
Credential: MD
Phone: 803-957-8000