Provider Demographics
NPI:1154378214
Name:MUGHELLI, OLUMIDE MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:OLUMIDE
Middle Name:MICHAEL
Last Name:MUGHELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4740
Mailing Address - Country:US
Mailing Address - Phone:843-769-4424
Mailing Address - Fax:843-769-4425
Practice Address - Street 1:1843 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4740
Practice Address - Country:US
Practice Address - Phone:843-769-4424
Practice Address - Fax:843-769-4425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC146835Medicaid
SC146835Medicaid