Healthcare Provider Details

I. General information

NPI: 1053311282
Provider Name (Legal Business Name): KENNETH D WEEKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 RANDOLPH RD SUITE 101
CHARLOTTE NC
28211-1047
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-7910
  • Fax: 704-384-7914
Mailing address:
  • Phone: 704-316-3820
  • Fax: 704-316-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22644
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number22644
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: