Healthcare Provider Details

I. General information

NPI: 1982650735
Provider Name (Legal Business Name): CARMEL FOOT SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S TORRENCE ST
CHARLOTTE NC
28204-3071
US

IV. Provider business mailing address

717 S TORRENCE ST
CHARLOTTE NC
28204-2927
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-8682
  • Fax: 704-334-0754
Mailing address:
  • Phone: 704-334-8682
  • Fax: 704-334-0754

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: MR. RICHARD J MILLER
Title or Position: PRESIDENT
Credential: DPM
Phone: 704-334-8682