Healthcare Provider Details

I. General information

NPI: 1891809893
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER DESANTIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 46TH AVENUE DR NE
HICKORY NC
28601-7318
US

IV. Provider business mailing address

608 46TH AVENUE DR NE
HICKORY NC
28601-7318
US

V. Phone/Fax

Practice location:
  • Phone: 828-320-2972
  • Fax: 828-465-0811
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 Number9800233
License Number StateNC

VIII. Authorized Official

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