Healthcare Provider Details

I. General information

NPI: 1639798002
Provider Name (Legal Business Name): MICHAEL STEVEN NOKES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/26/2024
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 BLUE RIDGE ROAD SUITE 100
RALEIGH NC
27607
US

IV. Provider business mailing address

2406 BLUE RIDGE ROAD SUITE 100
RALEIGH NC
27607-6692
US

V. Phone/Fax

Practice location:
  • Phone: 919-786-5001
  • Fax: 919-786-5051
Mailing address:
  • Phone: 919-786-5001
  • Fax: 919-786-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023-02042
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number2023-02042
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: