Healthcare Provider Details

I. General information

NPI: 1992333504
Provider Name (Legal Business Name): KATHERINE MARIE MIELKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE MARIE BUDDEMEYER MD

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 STEELECROFT PKWY STE 240
CHARLOTTE NC
28278-7799
US

IV. Provider business mailing address

421 KIMBRELL CROSSING DR
FORT MILL SC
29715-9000
US

V. Phone/Fax

Practice location:
  • Phone: 704-512-2860
  • Fax:
Mailing address:
  • Phone: 573-673-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number92080
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2024-01140
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: