Provider Demographics
NPI:1386619369
Name:ODLE, MICHEAL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:A
Last Name:ODLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 SINGLETON RIDGE ROAD
Mailing Address - Street 2:ATTENTION PATIENT ACCOUNTING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:2376 CYPRESS CIR
Practice Address - Street 2:STE 102
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8964
Practice Address - Country:US
Practice Address - Phone:843-347-8953
Practice Address - Fax:843-347-0226
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-08-09
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Provider Licenses
StateLicense IDTaxonomies
SC84064207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC840647Medicaid