Individual
DR. MICHAEL ERNEST THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
425 SUMMIT TERRACE CT BLDG 7A, COLUMBIA, SC 29229-7055
(803) 788-6400
(803) 788-6544
Mailing address
425 SUMMIT TERRACE CT BLDG 7A, COLUMBIA, SC 29229-7055
(803) 788-6400
(803) 788-6544
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
627
SC
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
627
SC
213ES0131X
Foot Surgery Podiatrist
627
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PD6279
—
SC
Enumeration date
03/20/2011
Last updated
09/20/2022
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