Basic Information
| Provider Information | |||||||||
| NPI: | 1376822627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINTER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 929 BOWMAN RD | ||||||||
| Address2: | STE 400 | ||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294643237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437304124 | ||||||||
| FaxNumber: | 8438064295 | ||||||||
| Practice Location | |||||||||
| Address1: | 929 BOWMAN RD | ||||||||
| Address2: | STE 400 | ||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294643237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437304124 | ||||||||
| FaxNumber: | 8438064295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2011 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.200517 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA3222 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.