MEDICARE: CAROLINA FOOT & ANKLE OF HUNTERSVILLE, PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1497376370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FOOT & ANKLE OF HUNTERSVILLE, PC

Provider Business Mailing Address
First Line	:	16419 NORTHCROSS DR STE A
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5009
Country	:	US
Telephone Number	:	704-987-9585
Fax Number	:	704-987-9589

Provider Business Practice Location Address
First Line	:	10310 COULOAK DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-7673
Country	:	US
Telephone Number	:	704-971-4000
Fax Number	:	704-971-2379

Authorized Official
Title or Position	:	DPM
Name	:	MARK ALAN QUIST
Credential	:
Telephone Number	:	704-987-9585

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	05/01/2020

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