Individual
DR. MICHAEL ANTHONY PETRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
157 WILLIAM HILTON PKWY, HILTON HEAD ISLAND, SC 29926-5218
(843) 842-2273
Mailing address
PO BOX 21372, HILTON HEAD ISLAND, SC 29925-1372
(438) 422-2738
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1966
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1966
SOUTH CAROLINA BOARD OF MEDICAL EXAMINER
SC
Enumeration date
08/16/2013
Last updated
11/06/2018
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