Individual
LAURE A.N. UTECHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE A200, GREENVILLE, SC 29615-3593
(864) 454-5130
(864) 454-5126
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
20991
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209919
—
SC
01
—
370017228
RR MEDICARE
SC
01
—
576007863095
BCBS OF SC ID
SC
01
—
576007863096
BLUE CHOICE OF SC
SC
01
—
7928169
AETNA ID
SC
Enumeration date
06/18/2006
Last updated
09/04/2013
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