Healthcare Provider Details

I. General information

NPI: 1699754127
Provider Name (Legal Business Name): MICAHEL WITKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W WILSON AVE
MOORESVILLE NC
28117-8811
US

IV. Provider business mailing address

930 W WILSON AVE
MOORESVILLE NC
28117-8811
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-7500
  • Fax: 704-799-2613
Mailing address:
  • Phone: 704-663-7500
  • Fax: 704-799-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: