| Lake Park Family Practice | |
|
6208 Creft Cir Suite 222 Indian Trail NC 28079-9003 | |
| (704) 882-1666 | |
| (704) 882-2789 |
| Full Name | Lake Park Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 6208 Creft Cir, Indian Trail, North Carolina |
| Authorized Official Name and Position | Daniel L Wiens (SENIOR VICE PRESIDENT) |
| Authorized Official Contact | 7043550648 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Park Family Practice Po Box 60643 Charlotte NC 28260-0643 Ph: (704) 882-1666 | Lake Park Family Practice 6208 Creft Cir Suite 222 Indian Trail NC 28079-9003 Ph: (704) 882-1666 |
| NPI Number | 1578572939 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 06/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578572939 | NPI | - | NPPES |
| 7705363 | Other | NC | NC MEDICAID DME SUPPLIER |
| 014PK | Other | NC | BLUE CROSS - BLUE SHIELD |
| 89014PK | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Indian Trail Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4503 Old Monroe Rd, Indian Trail, NC 28079 Phone: 704-821-6900 Fax: 704-821-6911 | |
Indian Trail Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4503 Old Monroe Rd, Indian Trail, NC 28079 Phone: 704-821-6900 Fax: 704-821-6911 | |
Indian Trail Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4503 Old Monroe Rd, Indian Trail, NC 28079 Phone: 980-993-7100 | |
Dove Internal Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6030 Hwy 74, Suite D, Indian Trail, NC 28079 Phone: 704-246-2800 Fax: 704-246-2888 | |
Sports Medicine And Injury Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6050 W Highway 74, Indian Trail, NC 28079 Phone: 704-863-4878 | |
Union Endocrinology Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4503 Old Monroe Rd, Suite A, Indian Trail, NC 28079 Phone: 704-684-0003 Fax: 704-684-0041 | |
Lake Park Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6208 Creft Cir, Ste 222, Indian Trail, NC 28079 Phone: 980-993-7150 |