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General NPI Number Information
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NPI Number | 1467598920
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY MEDICAL CARE, LLC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 181 BLUFFTON RD BLDG G101G102
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City | BLUFFTON
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State | SC
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Zip | 29910-6221
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Country | US
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Telephone | 843-757-5400
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Fax | 843-757-2240
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Provider Business Mailing Address
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Address Line | PO BOX 2599
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City | BLUFFTON
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State | SC
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Zip | 29910
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Country | US
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Telephone | 843-757-5400
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Fax | 843-757-2240
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. MICHAEL K MIKKELSON
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Credential | MD
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Telephone | 843-757-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15315
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License Number State | SC
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