Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 3413 | NC |
NPI | 1073537759 |
---|---|
Provider Name | Dr. Blake William Prelipp |
First Address | Charlotte, NC 28209-3490 |
Second Address | Charlotte, NC 28209-3490 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |