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General NPI Number Information
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NPI Number | 1477721843
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Entity Type | Organization
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Legal Business Name | MICHAEL G. RALLIS, M.D., PLLC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 2778 COUNTRY CLUB DR
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City | HAMPSTEAD
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State | NC
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Zip | 28443-8028
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Country | US
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Telephone | 910-259-5011
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Fax | 910-259-3060
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Provider Business Mailing Address
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Address Line | PO BOX 1179
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City | BURGAW
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State | NC
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Zip | 28425-1179
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Country | US
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Telephone | 910-259-5011
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Fax | 910-259-3060
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL GEORGE RALLIS
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Credential | MD
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Telephone | 910-259-5011
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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 | 23750
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License Number State | NC
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