Healthcare Provider Details

I. General information

NPI: 1598925166
Provider Name (Legal Business Name): MICHELLE CHIDESTER LINKOUS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 MOORE RD STE 201
KING NC
27021-8770
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-673-6470
  • Fax: 336-673-6489
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2011-00534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: