| Michael Christopher Desantis | |
|
608 46th Avenue Dr Ne Hickory NC 28601-7318 | |
| (828) 320-2972 | |
| (828) 465-0811 |
| Full Name | Michael Christopher Desantis |
|---|---|
| Speciality | Family Medicine |
| Location | 608 46th Avenue Dr Ne, Hickory, North Carolina |
| Authorized Official Name and Position | Michael Christopher Desantis (PARTNER) |
| Authorized Official Contact | 8283046363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Christopher Desantis 608 46th Avenue Dr Ne Hickory NC 28601-7318 Ph: (828) 304-6363 | Michael Christopher Desantis 608 46th Avenue Dr Ne Hickory NC 28601-7318 Ph: (828) 320-2972 |
| NPI Number | 1891809893 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 01/26/2024 |
| Medicare PECOS PAC ID | 4688575533 |
|---|---|
| Medicare Enrollment ID | O20040115000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891809893 | NPI | - | NPPES |
| 1190C | Other | NC | BCBS |
| 89-1190C | Medicaid | NC | |
| DC4226 | Other | NC | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 9800233 (North Carolina) | Primary |
| Provider Name | Michael C Desantis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780610394 PECOS PAC ID: 6800794264 Enrollment ID: I20031222000804 |
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