MEDICARE: CARY ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS, P.A.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1740751767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARY ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS, P.A.

Provider Business Mailing Address
First Line	:	1120 SE CARY PKWY STE 100
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-7413
Country	:	US
Telephone Number	:	919-467-4992
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 LATTNER CT STE 300
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-9584
Country	:	US
Telephone Number	:	919-238-2400
Fax Number	:

Authorized Official
Title or Position	:	REVENUE AND SPECIAL OPERATIONS DIRE
Name	:	MICHELLE WHEELIN
Credential	:
Telephone Number	:	919-467-4992

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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