Provider Demographics
NPI:1649331729
Name:EDWARDS, MICHAEL L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:LAMAR
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9213 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9145
Mailing Address - Country:US
Mailing Address - Phone:843-572-2100
Mailing Address - Fax:843-572-2163
Practice Address - Street 1:1230 HOSPITAL DR
Practice Address - Street 2:STE A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3251
Practice Address - Country:US
Practice Address - Phone:843-572-2100
Practice Address - Fax:843-572-2163
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12973208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC129738Medicaid
SC129738Medicaid
SCA970787368Medicare ID - Type Unspecified