Provider Demographics
NPI:1821102245
Name:WILDSTEIN, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:WILDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:418 FOLLY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2625
Mailing Address - Country:US
Mailing Address - Phone:843-406-2771
Mailing Address - Fax:843-406-2789
Practice Address - Street 1:418 FOLLY RD
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2625
Practice Address - Country:US
Practice Address - Phone:843-406-2771
Practice Address - Fax:843-406-2789
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC24445207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCI58044Medicare UPIN