MEDICARE: GREENSBORO ENDOCRINOLOGY PLLC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	29888	NC

General Provider Information

NPI Number	:	1588077176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENSBORO ENDOCRINOLOGY PLLC

Provider Business Mailing Address
First Line	:	7 CORPORATE CENTER CT STE C
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-3839
Country	:	US
Telephone Number	:	336-378-1074
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 CORPORATE CENTER CT STE C
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-3839
Country	:	US
Telephone Number	:	336-378-1074
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. MICHAEL DAVID ALTHEIMER
Credential	:	M.D.
Telephone Number	:	336-378-1074

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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