Provider Demographics
NPI:1851329031
Name:TORKELSON, MICHAEL ROBERT (M D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:TORKELSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 JETFIRE PT
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5346
Mailing Address - Country:US
Mailing Address - Phone:540-532-6204
Mailing Address - Fax:
Practice Address - Street 1:3 PROGRESSIVE ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5165
Practice Address - Country:US
Practice Address - Phone:843-548-0533
Practice Address - Fax:843-815-9121
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00730705OtherRRMC
WV7516755OtherAETNA
WV3810003685Medicaid
WV92230OtherUNICARE
WV001717791OtherMS BCBS
F29315Medicare UPIN