Provider Demographics
NPI:1104801364
Name:SPERO, MICHELE L (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:SPERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1798
Mailing Address - Country:US
Mailing Address - Phone:803-957-8000
Mailing Address - Fax:803-957-9025
Practice Address - Street 1:719 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3432
Practice Address - Country:US
Practice Address - Phone:803-957-8000
Practice Address - Fax:803-957-9025
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC131011Medicaid
SC131011Medicaid