Provider Demographics
NPI:1952359317
Name:AVANT, MICHAEL GRANT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GRANT
Last Name:AVANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:6TH FLOOR, SUPPORT TOWER
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-7146
Practice Address - Fax:864-455-5380
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC193992080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC193999Medicaid
SCF879497951Medicare PIN
SC57-6007863032OtherBCBS OF SC
SCF87949Medicare UPIN
SCF879497951Medicare PIN
SC57-6007863006OtherBLUE CHOICE OF SC
SC5096682OtherAETNA
SCF879493640Medicare PIN