Healthcare Provider Details

I. General information

NPI: 1215621651
Provider Name (Legal Business Name): MICHAEL RODERIC FINK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BOULEVARD GROUND FLOOR MEADS HALL SUITE B
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

1067 NEWGATE DR
ALLENTOWN PA
18103-9265
US

V. Phone/Fax

Practice location:
  • Phone: 123-124-2747
  • Fax:
Mailing address:
  • Phone: 610-297-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: