Individual
DR. TEMISAN L ETIKERENTSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 EXECUTIVE PKWY, MONCKS CORNER, SC 29461-3930
(843) 899-9099
(843) 899-9091
Mailing address
783 NAVIGATORS RUN, MT. PLEASANT, SC 29464-2829
(843) 886-6729
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20234
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20 20234
STATE REGISTRATION
SC
01
—
20234
MEDICAL LICENSE
SC
05
—
202346
—
SC
01
—
562413454
SECONDARY TAX ID
SC
01
—
562413454
FEDERAL IN
—
01
—
571134452
FEDERAL IN
—
01
—
75767
SC PCF
SC
01
—
9800859
MEDICAL LICENSE
NC
05
—
GP3438
—
SC
05
—
GP3914
—
SC
01
—
JB021564
JUA
SC
01
—
JB021584
JUA
—
Enumeration date
07/20/2005
Last updated
03/07/2023
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