Healthcare Provider Details

I. General information

NPI: 1497837561
Provider Name (Legal Business Name): BABAK MOKARI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12905 ROSEDALE HILL AVE
HUNTERSVILLE NC
28078-3341
US

IV. Provider business mailing address

PO BOX 601067
CHARLOTTE NC
28260-1067
US

V. Phone/Fax

Practice location:
  • Phone: 704-801-1000
  • Fax: 704-896-2861
Mailing address:
  • Phone: 704-801-1000
  • Fax: 704-896-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001-01105
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: