Jaenicke, Matthew Walter

Jaenicke, Matthew Walter is an sole proprietor health care provider with primary practice located at 1711 Saint Julian Pl , Columbia SC 29204-2409. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Rheumatology. Allopathic & Osteopathic Physicians / Rheumatology is his primary health care specialty. Jaenicke, Matthew Walter can be contacted via phone (803) 779-0911.

Contact Information

Primary practice address
1711 Saint Julian Pl Columbia SC 29204-2409
Phone: (803) 779-0911
Fax: (803) 256-2480
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X Vermont
Allopathic & Osteopathic Physicians / Rheumatology 207RR0500X 38299 South Carolina

Profile Details

NPI number 1063892008
LBN Legal business name Jaenicke, Matthew Walter
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 4th, 2015
Last updated Nov 12th, 2020 - about 4 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 1063892008 NPPES
Vermont MEDICAID 0000030538

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