Healthcare Provider Details

I. General information

NPI: 1245257021
Provider Name (Legal Business Name): MIKELLE L KEY-SOLLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ERWIN RD
DURHAM NC
27705-3941
US

IV. Provider business mailing address

2100 ERWIN RD
DURHAM NC
27705-3941
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-8111
  • Fax:
Mailing address:
  • Phone: 919-684-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200501284
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierQ84005
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 2
Identifier5901552
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: