Provider Demographics
NPI:1265409130
Name:STINSON, MICHAEL SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:STINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3555 HARDEN STREET EXT
Mailing Address - Street 2:15 MEDICAL PARK SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6894
Mailing Address - Country:US
Mailing Address - Phone:803-545-5017
Mailing Address - Fax:803-255-3451
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:SUITE 501
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-540-1000
Practice Address - Fax:803-540-1050
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT21358Medicaid
SCE909262603Medicare PIN
SCT21358Medicaid
SCE668707004Medicare PIN
SCE909267579Medicare PIN
SCE668707004Medicare PIN