Healthcare Provider Details

I. General information

NPI: 1003203142
Provider Name (Legal Business Name): ANDREI YERIK HETMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 SUNSET BLVD STE 104
WEST COLUMBIA SC
29169-4838
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-0464
  • Fax: 803-254-5121
Mailing address:
  • Phone: 803-791-2491
  • Fax: 803-794-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME141138
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number96415
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: