Provider Demographics
NPI:1568470904
Name:BUCCI, MICHAEL N (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:BUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 SAINT FRANCIS DR
Mailing Address - Street 2:SUITE 490
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3971
Mailing Address - Country:US
Mailing Address - Phone:864-220-4263
Mailing Address - Fax:864-220-5836
Practice Address - Street 1:3 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 490
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3971
Practice Address - Country:US
Practice Address - Phone:864-220-4263
Practice Address - Fax:864-220-5836
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14321207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC143213Medicaid
GA00424388AMedicaid
SC14321OtherSTATE LICENSE NUMBER
SC14321OtherSTATE LICENSE NUMBER
SCBB1952729OtherDEA NUMBER
SCB488094306Medicare ID - Type Unspecified