Healthcare Provider Details

I. General information

NPI: 1932444320
Provider Name (Legal Business Name): MICHAEL P GIROUARD, MD WEIGHT LOSS AND WELLNESS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15806 BROOKWAY DR SUITE 400
HUNTERSVILLE NC
28078-3237
US

IV. Provider business mailing address

15806 BROOKWAY DR SUITE 400
HUNTERSVILLE NC
28078-3237
US

V. Phone/Fax

Practice location:
  • Phone: 704-766-1000
  • Fax: 704-766-1002
Mailing address:
  • Phone: 704-766-1000
  • Fax: 704-766-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number9900053
License Number StateNC

VIII. Authorized Official

Name: DR. MICHAEL PAUL GIROUARD
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 704-766-1000