Provider Demographics
NPI:1457326258
Name:BOOK, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BOOK
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:PO BOX 751357
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1357
Mailing Address - Country:US
Mailing Address - Phone:843-768-0888
Mailing Address - Fax:843-768-1577
Practice Address - Street 1:5480 SEA FOREST DR
Practice Address - Street 2:
Practice Address - City:KIAWAH ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-5417
Practice Address - Country:US
Practice Address - Phone:843-768-0888
Practice Address - Fax:843-768-1577
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC177542Medicaid
SCF360457680Medicare PIN
SC177542Medicaid