Endicott, Michelle Leigh

Endicott, Michelle Leigh is an sole proprietor health care provider with primary practice located at 4815 Kanawha Ave Sw , South Charleston WV 25309-1207. She recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as her primary health care specialty. Endicott, Michelle Leigh can be contacted via phone (304) 768-4567.

Contact Information

Primary practice address
4815 Kanawha Ave Sw South Charleston WV 25309-1207
Phone: (304) 768-4567
Fax: (304) 768-2277
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 2097 West Virginia

Profile Details

NPI number 1699774315
LBN Legal business name Endicott, Michelle Leigh
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 14th, 2005
Last updated Sep 11th, 2012 - about 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699774315 NPPES
West Virginia MEDICAID 3810002529

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