MEDICARE: DR. JOSEPH MICHAEL DEGULIS 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
1	207P00000X	Emergency Medicine Physician	19025	SC
2	207P00000X	Emergency Medicine Physician	97-00228	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E520949326	OTHER	SC	MEDICARE FOR SOUTH CAROLINA

General Provider Information

NPI Number	:	1831162031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MICHAEL DEGULIS MD

Provider Business Mailing Address
First Line	:	255 FORESAIL RD
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28146-9467
Country	:	US
Telephone Number	:	704-431-4922
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 FORESAIL RD
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28146-9467
Country	:	US
Telephone Number	:	704-431-4922
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	06/03/2021

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