Healthcare Provider Details

I. General information

NPI: 1669411963
Provider Name (Legal Business Name): MICHAEL SPRUIELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S INDEPENDENCE BLVD SUITE 5
VIRGINIA BEACH VA
23453-4776
US

IV. Provider business mailing address

2020 S INDEPENDENCE BLVD SUITE 5
VIRGINIA BEACH VA
23453-4776
US

V. Phone/Fax

Practice location:
  • Phone: 757-471-6903
  • Fax: 757-471-3974
Mailing address:
  • Phone: 757-471-6903
  • Fax: 757-471-3974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101035982
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: