Healthcare Provider Details

I. General information

NPI: 1326024498
Provider Name (Legal Business Name): MICHELE DUVAL NACOUZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ALM ST SUITE 1100
RALEIGH NC
27617-8221
US

IV. Provider business mailing address

7021 HARPS MILL RD STE 100
RALEIGH NC
27615-3240
US

V. Phone/Fax

Practice location:
  • Phone: 919-484-8345
  • Fax: 919-419-8218
Mailing address:
  • Phone: 919-620-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9500164
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: