Basic Information
| Provider Information | |||||||||
| NPI: | 1508841859 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | POLETTI | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 DOZIER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295014090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436695162 | ||||||||
| FaxNumber: | 8436674573 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 CHUCK DAWLEY BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294644183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438491551 | ||||||||
| FaxNumber: | 8438841174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 11/09/2009 | ||||||||
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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 | 207XS0117X | 15858 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 320058385 | 01 | SC | STANDARD TAX ID | OTHER | TL8418 | 05 | SC | MEDICAID |