Bolden Ravenell, Tamika M
Bolden Ravenell, Tamika M is an sole proprietor health care provider with primary practice located at 180 Wingo Way Suite 201, Mount Pleasant SC 29464-1810. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as her primary health care specialty. Bolden Ravenell, Tamika M can be contacted via phone (843) 856-5337.Contact Information
Primary practice address
180 Wingo Way Suite 201
Mount Pleasant SC 29464-1810
Phone: (843) 856-5337
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | POD.607 POD | South Carolina |
Profile Details
| NPI number | 1598924581 |
|---|---|
| LBN Legal business name | Bolden Ravenell, Tamika M |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 4th, 2008 |
| Last updated | Dec 13th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598924581 | NPPES |
| South Carolina | MEDICAID | GP9889 |
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