MEDICARE: SOUTH CHARLOTTE CARDIOLOGY, P.C.

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	200200495	NC

General Provider Information

NPI Number	:	1316171630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CHARLOTTE CARDIOLOGY, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 472423
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28247-2423
Country	:	US
Telephone Number	:	704-321-2741
Fax Number	:	803-396-8232

Provider Business Practice Location Address
First Line	:	11220 ELM LN STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0450
Country	:	US
Telephone Number	:	704-321-2741
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	KULPREET K LIU
Credential	:	M.D.
Telephone Number	:	704-321-2741

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	01/25/2022

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