MEDICARE: WAKEMED SPECIALISTS GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1023837929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKEMED SPECIALISTS GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 603949
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-3949
Country	:	US
Telephone Number	:	877-498-4490
Fax Number	:	919-350-7687

Provider Business Practice Location Address
First Line	:	1030 SIENA DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2781
Country	:	US
Telephone Number	:	919-232-5020
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR FINANCE
Name	:	MICHAEL PAUL DUFFEY
Credential	:
Telephone Number	:	919-350-8000

Provider Enumeration Date	:	10/08/2024
Last Update Date	:	10/08/2024

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Directions to “WAKEMED SPECIALISTS GROUP LLC ” Practice Location

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