Healthcare Provider Details

I. General information

NPI: 1790528180
Provider Name (Legal Business Name): MAGDY ISSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15114 TORRENCE BRANCH RD
CHARLOTTE NC
28278-5829
US

IV. Provider business mailing address

15114 TORRENCE BRANCH RD
CHARLOTTE NC
28278-5829
US

V. Phone/Fax

Practice location:
  • Phone: 515-745-3469
  • Fax:
Mailing address:
  • Phone: 515-745-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MAGDY K ISSA
Title or Position: OWNER
Credential: DPM
Phone: 515-745-3469