Basic Information
| Provider Information | |||||||||
| NPI: | 1659783280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOUSSAINT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 MEMORIAL MEDICAL CT STE 1 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642953492 | ||||||||
| FaxNumber: | 8642954817 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 MEMORIAL MEDICAL CT STE 1 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642953492 | ||||||||
| FaxNumber: | 8642954817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2014 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 52579 | SC | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0102X | 52579 | SC | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.