Provider Demographics
NPI:1326034729
Name:BAUERSCHMIDT, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BAUERSCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JOHNNIE DODDS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3082
Mailing Address - Country:US
Mailing Address - Phone:954-493-8178
Mailing Address - Fax:954-493-8459
Practice Address - Street 1:615 JOHNNIE DODDS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3082
Practice Address - Country:US
Practice Address - Phone:843-936-6451
Practice Address - Fax:843-936-6452
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57198207P00000X, 207QA0505X
SC13315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81740Medicare UPIN