Provider Demographics
NPI:1447442835
Name:MICHELE L SPERO
Entity type:Organization
Organization Name:MICHELE L SPERO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-957-8000
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1798
Mailing Address - Country:US
Mailing Address - Phone:803-957-8000
Mailing Address - Fax:803-957-9025
Practice Address - Street 1:719 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3432
Practice Address - Country:US
Practice Address - Phone:803-957-8000
Practice Address - Fax:803-957-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3135Medicare PIN