Basic Information
| Provider Information | |||||||||
| NPI: | 1780660639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANDRE' | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1245 | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291161245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033954497 | ||||||||
| FaxNumber: | 8035360998 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 COOK RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291188201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035362555 | ||||||||
| FaxNumber: | 8035360998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 06/20/2012 | ||||||||
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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 | 208600000X | 21888 | SC | Y | Allopathic & Osteopathic Physicians | Surgery | 202K00000X | 21888 | SC | N | Allopathic & Osteopathic Physicians | Phlebology |
ID Information
| ID | Type | State | Issuer | Description | 20003459 | 01 | SC | FIRST CHOICE | OTHER | A6765 | 01 | SC | MEDCOST | OTHER | 57680010-012 | 01 | SC | BCBS | OTHER | T59674 | 05 | SC | MEDICAID | 9645030 | 01 | SC | GHI | OTHER |