Healthcare Provider Details

I. General information

NPI: 1548223092
Provider Name (Legal Business Name): JOSEPH JOHN ESTWANIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BILLINGSLEY RD
CHARLOTTE NC
28211-1040
US

IV. Provider business mailing address

335 BILLINGSLEY RD
CHARLOTTE NC
28211-1040
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-4663
  • Fax: 704-343-0811
Mailing address:
  • Phone: 704-334-4663
  • Fax: 704-343-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number18633
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: