Provider Demographics
NPI:1780881185
Name:KAMANDA, MICHAEL OLIVER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OLIVER
Last Name:KAMANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-2025
Mailing Address - Country:US
Mailing Address - Phone:843-423-0760
Mailing Address - Fax:843-423-8138
Practice Address - Street 1:1115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2025
Practice Address - Country:US
Practice Address - Phone:843-423-0760
Practice Address - Fax:843-423-8138
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine