Provider Demographics
NPI:1154168631
Name:TOWE, MICHAEL LEROY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEROY
Last Name:TOWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 THREADGILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-3328
Mailing Address - Country:US
Mailing Address - Phone:864-720-3205
Mailing Address - Fax:
Practice Address - Street 1:1324 THREADGILL DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3328
Practice Address - Country:US
Practice Address - Phone:864-720-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC249974163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine