Healthcare Provider Details

I. General information

NPI: 1134152002
Provider Name (Legal Business Name): MICHAEL D GWINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

400 KEISLER DR
CARY NC
27518-7069
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8779
  • Fax: 919-350-8812
Mailing address:
  • Phone: 919-781-9078
  • Fax: 919-719-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number39180
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: