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General NPI Number Information
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NPI Number | 1528091584
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY CARE OF SC, LLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 109 BURTON AVE SUITE E
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8117
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Country | US
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Telephone | 843-832-6875
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Fax | 843-832-6878
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Provider Business Mailing Address
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Address Line | 109 BURTON AVE SUITE E
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8117
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Country | US
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Telephone | 843-832-6875
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Fax | 843-832-6878
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL LAM
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Credential | MD
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Telephone | 843-932-6875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 11269
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License Number State | SC
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