Individual
DR. MICHELE A MITTELBRONN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
999 LAKE HUNTER CIR, SUITE B, MT PLEASANT, SC 29464-5427
(843) 881-2265
(843) 881-2789
Mailing address
999 LAKE HUNTER CIR, SUITE B, MT PLEASANT, SC 29464-5427
(843) 881-2265
(843) 881-2789
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
22838
SC
207ND0900X
Dermatopathology Physician
22838
SC
207NP0225X
Pediatric Dermatology Physician
22838
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200070804
TAX ID
SC
Enumeration date
05/16/2006
Last updated
09/22/2011
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