| Wake Family Medicine Pc | |
|
1831 Lake Pine Dr Ste 200 Cary NC 27511-6050 | |
| (919) 380-1849 | |
| (919) 380-1851 |
| Full Name | Wake Family Medicine Pc |
|---|---|
| Speciality | General Practice |
| Location | 1831 Lake Pine Dr Ste 200, Cary, North Carolina |
| Authorized Official Name and Position | Mrinalini Sujala Kodumagulla (OWNER/PHYSICAN) |
| Authorized Official Contact | 9193953491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake Family Medicine Pc 1831 Lake Pine Dr Ste 200 Cary NC 27511-6050 Ph: (919) 380-1849 | Wake Family Medicine Pc 1831 Lake Pine Dr Ste 200 Cary NC 27511-6050 Ph: (919) 380-1849 |
| NPI Number | 1215162466 |
|---|---|
| Provider Enumeration Date | 05/18/2009 |
| Last Update Date | 09/30/2019 |
| Medicare PECOS PAC ID | 0244381309 |
|---|---|
| Medicare Enrollment ID | O20090630000648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215162466 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Mrinalini S Kodumagulla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043467665 PECOS PAC ID: 6901966811 Enrollment ID: I20081122000089 |
| Provider Name | Heather Lea Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578984167 PECOS PAC ID: 6406087766 Enrollment ID: I20140331000214 |
| Provider Name | Olga A Shalaurova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649607607 PECOS PAC ID: 7113156332 Enrollment ID: I20141105001493 |
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