Healthcare Provider Details

I. General information

NPI: 1568763795
Provider Name (Legal Business Name): DESANTIS FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 3RD AVE NE
HICKORY NC
28601-5044
US

IV. Provider business mailing address

10 3RD AVE NE
HICKORY NC
28601-5044
US

V. Phone/Fax

Practice location:
  • Phone: 828-304-6363
  • Fax: 828-304-0033
Mailing address:
  • Phone: 828-304-6363
  • Fax: 828-304-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. MICHAEL CHRISTOPHER DESANTIS
Title or Position: PHYSICIAN
Credential: MD
Phone: 828-304-6363