Provider Demographics
NPI:1174715809
Name:MICHAELIS, CHRISTOPHER MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:MICHAELIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 WINGO WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1810
Mailing Address - Country:US
Mailing Address - Phone:843-800-1215
Mailing Address - Fax:843-800-1215
Practice Address - Street 1:180 WINGO WAY STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-800-1215
Practice Address - Fax:843-800-1215
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67506207P00000X
SC1399207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC013997Medicaid
SC1399OtherMEDICAL LICENSE
GA003121715EMedicaid
GA67506OtherGA MEDICAL LICENSE