MEDICARE: DR. CURTIS WAYNE SCHUPBACH 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	207N00000X	Dermatology Physician	19542	NC

General Provider Information

NPI Number	:	1093707382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CURTIS WAYNE SCHUPBACH MD

Provider Business Mailing Address
First Line	:	2620 E 7TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-4314
Country	:	US
Telephone Number	:	704-358-9900
Fax Number	:	704-344-0105

Provider Business Practice Location Address
First Line	:	2620 E 7TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-4314
Country	:	US
Telephone Number	:	704-358-9900
Fax Number	:	704-344-0105

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	01/26/2010

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