Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 9500383 | NC |
NPI | 1073584843 |
---|---|
Provider Name | Allan Krusell |
First Address | Charlotte, NC 28219-9305 |
Second Address | Concord, NC 28025-2982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E88524 | (02) | NC |