Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10641 | NC |
Y | 213EG0000X | General Practice | 10641 | NC |
NPI | 1003345752 |
---|---|
Provider Name | Michael Vick |
First Address | Charlotte, NC 28203-6483 |
Second Address | Denver, NC 28037-8254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2017 |
Last Update Date | 07/06/2017 |