Organization
COASTAL GRANDE OB-GYN,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH SPIELVOGEL MD (OWNER/M.D.)
(843) 421-8200
Entity
Organization
Contact information
Practice address
1021 CIPRIANA DRIVE, SUITE 250, MYRTLE BEACH, SC 29572-4619
(843) 421-8200
(843) 839-3634
Mailing address
1021 CIPRIANA DRIVE, SUITE 250, MYRTLE BEACH, SC 29572-4619
(843) 421-8200
(843) 839-3634
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4188
—
SC
Enumeration date
06/04/2006
Last updated
07/21/2011
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