Healthcare Provider Details

I. General information

NPI: 1003159617
Provider Name (Legal Business Name): BIO-LIFECYCLE MEDICAL CENTERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE BOONE TRL STE 005
RALEIGH NC
27607-7512
US

IV. Provider business mailing address

4201 LAKE BOONE TRL STE 005
RALEIGH NC
27607-7512
US

V. Phone/Fax

Practice location:
  • Phone: 919-851-9100
  • Fax:
Mailing address:
  • Phone: 919-851-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number39759
License Number StateNC

VIII. Authorized Official

Name: MIKE MONTEMURRO
Title or Position: COO
Credential:
Phone: 919-851-9100