| Lake Norman Endocrinology & Diabetes, Pc | |
|
143 Joe Knox Ave Suite 100 Mooresville NC 28117-9243 | |
| (704) 664-2936 | |
| Not Available |
| Full Name | Lake Norman Endocrinology & Diabetes, Pc |
|---|---|
| Speciality | Internal Medicine - Endocrinology, Diabetes & Metabolism |
| Location | 143 Joe Knox Ave, Mooresville, North Carolina |
| Authorized Official Name and Position | Augustine U Obi (OWNER) |
| Authorized Official Contact | 7046642910 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Norman Endocrinology & Diabetes, Pc 143 Joe Knox Ave Suite 100 Mooresville NC 28117-9243 Ph: (704) 664-2936 | Lake Norman Endocrinology & Diabetes, Pc 143 Joe Knox Ave Suite 100 Mooresville NC 28117-9243 Ph: (704) 664-2936 |
| NPI Number | 1114205457 |
|---|---|
| Provider Enumeration Date | 08/03/2011 |
| Last Update Date | 09/26/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114205457 | NPI | - | NPPES |
| 5918299 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 9400602 (North Carolina) | Primary |
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