Individual
DR. MICHAEL SUPPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
GRADUATE MEDICAL EDUCATION OFC, MEDICAL CENTER BOULEVARD, WINSTON SALEM, NC 27157
(336) 716-4629
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01081839A
IN
207P00000X
Emergency Medicine Physician
2018-01503
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2016
Last updated
06/04/2019
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