Healthcare Provider Details

I. General information

NPI: 1639217821
Provider Name (Legal Business Name): MICHAEL L MASIOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 MIDLAND PKWY
SUMMERVILLE SC
29485-8104
US

IV. Provider business mailing address

PO BOX 11450
WESTMINSTER CA
92685-1450
US

V. Phone/Fax

Practice location:
  • Phone: 843-832-5000
  • Fax:
Mailing address:
  • Phone: 800-509-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21764
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: