Healthcare Provider Details

I. General information

NPI: 1124061924
Provider Name (Legal Business Name): CHARLES CHIKE ANIKWUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 RANDOLPH RD STE. 206
CHARLOTTE NC
28207-1105
US

IV. Provider business mailing address

PO BOX 680447
CHARLOTTE NC
28216-0008
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-3308
  • Fax: 704-332-3358
Mailing address:
  • Phone: 704-332-3308
  • Fax: 704-332-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22208
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101037694
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number48288-020
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-103874
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number45318
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301085899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: