| Wake Forest Internal Medicine And Primary Care | |
|
1751 S Main St Wake Forest NC 27587-9287 | |
| (919) 556-7499 | |
| (919) 562-0943 |
| Full Name | Wake Forest Internal Medicine And Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 1751 S Main St, Wake Forest, North Carolina |
| Authorized Official Name and Position | Mohammad Abul Kalam Khan (PRESIDENT) |
| Authorized Official Contact | 9195567499 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake Forest Internal Medicine And Primary Care 1751 S Main St Wake Forest NC 27587-9287 Ph: (919) 556-7499 | Wake Forest Internal Medicine And Primary Care 1751 S Main St Wake Forest NC 27587-9287 Ph: (919) 556-7499 |
| NPI Number | 1568433282 |
|---|---|
| Provider Enumeration Date | 01/30/2006 |
| Last Update Date | 03/14/2012 |
| Medicare PECOS PAC ID | 8729178918 |
|---|---|
| Medicare Enrollment ID | O20071211000789 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568433282 | NPI | - | NPPES |
| 890267T | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 9500635 (North Carolina) | Primary |
| Provider Name | Mohammad Abul Kalam Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538131974 PECOS PAC ID: 4183714371 Enrollment ID: I20071211000784 |
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