Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 34098 | NC |
NPI | 1003801440 |
---|---|
Provider Name | Michael J Mcnelis |
First Address | Charlotte, NC 28207-1437 |
Second Address | Charlotte, NC 28207-1437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 20/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8959063 | (05) | NC |
E22884 | (02) | NC |