MEDICARE: KENNETH D WEEKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	22644	NC
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	22644	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053311282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH D WEEKS MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-3820
Fax Number	:	704-316-3825

Provider Business Practice Location Address
First Line	:	2801 RANDOLPH RD
Second Line	:	SUITE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1047
Country	:	US
Telephone Number	:	704-384-7910
Fax Number	:	704-384-7914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/28/2015

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