Provider Demographics
NPI:1174082184
Name:FROST, MICHAEL M (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:FROST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTN PNS CREDENTIALING
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 1:2701 CHURCH ST
Practice Address - Street 2:STE A
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4422
Practice Address - Country:US
Practice Address - Phone:843-365-0295
Practice Address - Fax:843-365-0354
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC82192207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC821927Medicaid