Healthcare Provider Details

I. General information

NPI: 1558321679
Provider Name (Legal Business Name): MICHAEL DAVID LENKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/12/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3623 LATROBE DR STE 216
CHARLOTTE NC
28211-1187
US

IV. Provider business mailing address

PO BOX 221249
CHARLOTTE NC
28222-1249
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-1291
  • Fax: 704-332-5206
Mailing address:
  • Phone: 704-332-1291
  • Fax: 704-332-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number9701032
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number009701032
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: