Provider Demographics
NPI:1154433688
Name:FIELDS, MICHAEL JAY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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 1:200 PATEWOOD DR STE A300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6303
Practice Address - Country:US
Practice Address - Phone:864-454-5530
Practice Address - Fax:864-241-9246
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC376962080P0214X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376961Medicaid
SCSC49087951Medicare PIN