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NPI Code Detail

MEDICARE: MICHAEL KEASLER WELBORN MD

MEDICARE:   MICHAEL KEASLER WELBORN  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician5415SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1582296052-055OTHERSCBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639120439
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL KEASLER WELBORN MD
Provider Business Mailing Address
First Line : PO BOX 1315
Second Line :
City : EASLEY
State : SC
Zip : 29641-1315
Country : US
Telephone Number : 864-635-0376
Fax Number : 864-442-6848
Provider Business Practice Location Address
First Line : 115 BRUSHY CREEK RD
Second Line :
City : EASLEY
State : SC
Zip : 29642-1120
Country : US
Telephone Number : 864-635-0376
Fax Number : 864-442-6848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2006
Last Update Date : 10/13/2021

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Directions to “ MICHAEL KEASLER WELBORN MD” Practice Location

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