Provider Demographics
NPI:1386902286
Name:PETERS, MICHAEL LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LLOYD
Last Name:PETERS
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 1:118 SPRINGHALL DR
Mailing Address - Street 2:STE A
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5360
Mailing Address - Country:US
Mailing Address - Phone:864-915-0468
Mailing Address - Fax:
Practice Address - Street 1:398 THE PKWY
Practice Address - Street 2:MOUNTAIN VIEW FAMILY MEDICINE
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4569
Practice Address - Country:US
Practice Address - Phone:864-877-9577
Practice Address - Fax:864-877-9073
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC349251207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC349251Medicaid
SC349251Medicaid
SC349251Medicaid