Organization
COASTAL DERMATOLOGY INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CENTILLI DO (OWNER)
(517) 203-6532
Entity
Organization
Contact information
Practice address
199 VILLAGE CENTER BLVD STE 200, MYRTLE BEACH, SC 29579-3589
(843) 738-0500
Mailing address
199 VILLAGE CENTER BLVD STE 200, MYRTLE BEACH, SC 29579-3589
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Enumeration date
10/19/2020
Last updated
06/02/2021
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