Basic Information
| Provider Information | |||||||||
| NPI: | 1750479598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBOYLE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 PATEWOOD DR | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296153581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642349900 | ||||||||
| FaxNumber: | 8642349090 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 PATEWOOD DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296153589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642349900 | ||||||||
| FaxNumber: | 8642349090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 01/07/2014 | ||||||||
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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 | 207X00000X | 19958 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 199582 | 05 | SC | MEDICAID |