MEDICARE: DR. MICHAEL EVERETT FENNER

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
1	251E00000X	Home Health Agency		SC

General Provider Information

NPI Number	:	1760332365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EVERETT FENNER

Provider Business Mailing Address
First Line	:	18 EXECUTIVE PARK RD STE 7A
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4739
Country	:	US
Telephone Number	:	305-509-0091
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 EXECUTIVE PARK RD STE 7A
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4739
Country	:	US
Telephone Number	:	305-509-0091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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