Healthcare Provider Details

I. General information

NPI: 1093713455
Provider Name (Legal Business Name): CARMEL FOOT SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10370 PARK RD STE. 100
CHARLOTTE NC
28210-8508
US

IV. Provider business mailing address

10370 PARK RD STE. 100
CHARLOTTE NC
28210-8508
US

V. Phone/Fax

Practice location:
  • Phone: 704-542-8253
  • Fax: 704-541-0186
Mailing address:
  • Phone: 704-542-8253
  • Fax: 704-541-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD J MILLER
Title or Position: PRESIDENT
Credential: DPM
Phone: 704-542-8253