Individual
MRS. MICHELLE LEIGH ENDICOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4815 KANAWHA AVE SW, SOUTH CHARLESTON, WV 25309-1207
(304) 768-4567
(304) 768-2277
Mailing address
4815 KANAWHA AVE SW, SOUTH CHARLESTON, WV 25309-1207
(304) 768-4567
(304) 768-2277
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2097
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810002529
—
WV
Enumeration date
07/14/2005
Last updated
09/11/2012
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