Organization
DOMENIC J DEMICHELE,MD,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMENIC J DEMICHELE M.D., PH.D. (OWNER)
(843) 669-1615
Entity
Organization
Contact information
Practice address
125 S CASHUA DR, SUITE A, FLORENCE, SC 29501-4001
(843) 669-1615
(843) 669-1613
Mailing address
125 A CASHUA DR, FLORENCE, SC 29501
(843) 669-1615
(843) 669-1613
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
15062
SC
Other
Enumeration date
09/10/2007
Last updated
09/12/2007
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