Healthcare Provider Details

I. General information

NPI: 1487735494
Provider Name (Legal Business Name): CABARRUS PODIATRY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 BRADLEY ST
CONCORD NC
28025-2979
US

IV. Provider business mailing address

851 BRADLEY STREET
CONCORD NC
28025
US

V. Phone/Fax

Practice location:
  • Phone: 704-788-1142
  • Fax: 704-782-7912
Mailing address:
  • Phone: 704-788-1142
  • Fax: 704-782-7912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number150
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN MICHAEL DIEHL SR.
Title or Position: PRESIDENT
Credential: DPM
Phone: 704-788-1142