Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 29888 | NC |
NPI | 1053423434 |
---|---|
Provider Name | Dr. Michael David Altheimer |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27157-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 30/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10974 | BLUE CROSS BLUE SHIELD (01) | NC |
3300353 | UNITED HEALTHCARE OF NC (01) | NC |
8910974 | (05) | NC |
C82021 | (02) | NC |