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General NPI Number Information
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NPI Number | 1386843779
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE MEDICAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 5130 SOUTHPORT SUPPLY RD SE SUITE 101 A
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City | SOUTHPORT
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State | NC
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Zip | 28461-9261
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Country | US
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Telephone | 910-454-4032
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Fax | 910-454-4033
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Provider Business Mailing Address
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Address Line | 5130 SOUTHPORT SUPPLY RD SE SUITE 101 A
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City | SOUTHPORT
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State | NC
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Zip | 28461-9261
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Country | US
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Telephone | 910-454-4032
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Fax | 910-454-4033
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Authorized Official
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Title or Position | PHYSICIAN/OWENER
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Name | DR. SHERRY Z IKALOWYCH
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Credential | MD MS
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Telephone | 910-454-4032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 200500060
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License Number State | NC
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