Provider Demographics
NPI:1376645580
Name:SUTTON, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-841-3517
Mailing Address - Fax:843-841-3519
Practice Address - Street 1:705 N 8TH AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2549
Practice Address - Country:US
Practice Address - Phone:843-487-1588
Practice Address - Fax:843-487-1597
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS007501207XX0005X
SC457207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC064OtherBCBS
SC004578Medicaid
SC062OtherBLUECHOICE
SC207327OtherMEDCOST
SC4066223OtherAETNA
NC5909178Medicaid
E33199Medicare UPIN
SC004578Medicaid
9740027Medicare ID - Type Unspecified