=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245200161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL D SEEMULLER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2006
-----------------------------------------------------
Last Update Date | 11/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6650 HIGHWAY 81 NORTH
-----------------------------------------------------
City | PIEDMONT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-512-5910
-----------------------------------------------------
Fax | 864-512-5915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6650 HIGHWAY 81 NORTH
-----------------------------------------------------
City | PIEDMONT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-512-5910
-----------------------------------------------------
Fax | 864-512-5915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0101-234556
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 22632
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------