Healthcare Provider Details

I. General information

NPI: 1548740038
Provider Name (Legal Business Name): INDYCARE MEDICAL NORTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 S CANNON BLVD STE 101
KANNAPOLIS NC
28083-6104
US

IV. Provider business mailing address

101 GLEN LENNOX DR UNIT 300
CHAPEL HILL NC
27517-4089
US

V. Phone/Fax

Practice location:
  • Phone: 704-933-2273
  • Fax:
Mailing address:
  • Phone: 704-933-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA DOBSTAFF
Title or Position: PRESIDENT
Credential: MD
Phone: 919-619-3269