Healthcare Provider Details

I. General information

NPI: 1629530787
Provider Name (Legal Business Name): MACIE ENMAN TRUJILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACIE ALYSSA ENMAN MD

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MOREHEAD MEDICAL DR
CHARLOTTE NC
28204-2990
US

IV. Provider business mailing address

1021 MOREHEAD MEDICAL DR STE 6200
CHARLOTTE NC
28204-2994
US

V. Phone/Fax

Practice location:
  • Phone: 980-442-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2026-02378
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: