Healthcare Provider Details

I. General information

NPI: 1558314575
Provider Name (Legal Business Name): STEVEN G FOLSTAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 JOE V. KNOX AVENUE SUITE H
MOORESVILLE NC
28117-8104
US

IV. Provider business mailing address

2029 COLONY PINES DR
LELAND NC
28451-6470
US

V. Phone/Fax

Practice location:
  • Phone: 424-488-3467
  • Fax: 704-660-1396
Mailing address:
  • Phone: 704-617-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number34791
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34791
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: