Individual
MATTHEW WALTER JAENICKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
890 JOHNNIE DODDS BLVD SUITE 2A, MT PLEASANT, SC 29464
(843) 881-9971
(843) 881-9973
Mailing address
890 JOHNNIE DODDS BLVD SUITE 2A, MT PLEASANT, SC 29464
(843) 881-9971
(843) 881-9973
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
38299
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000030538
—
VT
Enumeration date
06/04/2015
Last updated
04/24/2025
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