Provider Demographics
NPI:1467915017
Name:COKER, MICHAEL AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AUSTIN
Last Name:COKER
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 1:96 JONATHAN LUCAS ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8900
Mailing Address - Country:US
Mailing Address - Phone:843-792-7179
Mailing Address - Fax:
Practice Address - Street 1:96 JONATHAN LUCAS ST STE 210
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8900
Practice Address - Country:US
Practice Address - Phone:843-792-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SCLL841552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program