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NPI Code Detail

MEDICARE: MS. MICHELLE ALMODOVAR BALMACEDA MD

MEDICARE: MS. MICHELLE ALMODOVAR BALMACEDA 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
1207Q00000XFamily Medicine Physician34762SC
2207Q00000XFamily Medicine Physician2016-01789NC

General Provider Information

NPI Number : 1164659819
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE ALMODOVAR BALMACEDA MD
Provider Business Mailing Address
First Line : PO BOX 751803
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1803
Country : US
Telephone Number : 704-384-8441
Fax Number : 704-384-8442
Provider Business Practice Location Address
First Line : 9600 E INDEPENDENCE BLVD
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-4628
Country : US
Telephone Number : 704-384-8441
Fax Number : 704-384-8442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2009
Last Update Date : 08/11/2021

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