Jaenicke, Matthew Walter
Jaenicke, Matthew Walter is an sole proprietor health care provider with primary practice located at 890 Johnnie Dodds Blvd Suite 2A , Mt Pleasant SC 29464. 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 (843) 881-9971.Contact Information
Primary practice address
890 Johnnie Dodds Blvd Suite 2A
Mt Pleasant SC 29464
Phone: (843) 881-9971
Fax: (843) 881-9973
Website:
Health care specialties
| Specialty | Code | License # | 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 | Apr 24th, 2025 - about last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063892008 | NPPES |
| Vermont | MEDICAID | 0000030538 |
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