Individual
KEVIN SPONSELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 MEDICAL PARK DR STE 207, HARTSVILLE, SC 29550-4778
(433) 832-7648
(843) 383-5171
Mailing address
701 MEDICAL PARK DR STE 207, HARTSVILLE, SC 29550-4778
(433) 832-7648
(843) 383-5171
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
—
—
207Q00000X
Family Medicine Physician
Primary
39188
SC
207Q00000X
Family Medicine Physician
62618-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
62618-20
WI
Other
Enumeration date
07/25/2014
Last updated
08/23/2023
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