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Individual

MICHAEL OLIPHANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
19526
NC
2085R0204X
Vascular & Interventional Radiology Physician
19526
NC
2085U0001X
Diagnostic Ultrasound Physician
19526
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
130K6
BCBS
NC
05
2005653000
WV
01
46205
PARTNERS
NC
05
7248164
VA
01
7816329
AETNA
05
89130K6
NC
01
B3170
MEDCOST
NC
05
Q19526
SC
Enumeration date
01/05/2006
Last updated
10/08/2010
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