Individual
MICHAEL S OTRUBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
161 TWO POND LOOP, LADSON, SC 29456-6917
(843) 475-1020
Mailing address
161 TWO POND LOOP, LADSON, SC 29456-6917
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
000312
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003123
—
SC
Enumeration date
12/14/2005
Last updated
08/01/2019
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