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General NPI Number Information
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NPI Number | 1174548028
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Entity Type | Organization
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Legal Business Name | NORTHLAKE NEPHROLOGY PLLC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 1665 DAVIE AVE
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City | STATESVILLE
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State | NC
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Zip | 28677-3519
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Country | US
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Telephone | 704-978-0052
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Fax | 704-978-0054
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Provider Business Mailing Address
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Address Line | 125 HENRY LN
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City | MOORESVILLE
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State | NC
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Zip | 28117-8767
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Country | US
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Telephone | 704-660-8878
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | SINASI SALMAN
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Credential | MD
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Telephone | 704-978-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 200200166
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License Number State | NC
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