Healthcare Provider Details

I. General information

NPI: 1164456422
Provider Name (Legal Business Name): MICHAEL J STOTZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 SUMMERPLACE DRIVE
WEST COLUMBIA SC
29169
US

IV. Provider business mailing address

9735 KINCEY AVE SUITE 201
HUNTERSVILLE NC
28078-9118
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-9968
  • Fax: 803-791-0376
Mailing address:
  • Phone: 704-414-2870
  • Fax: 704-414-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number208800000X
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: