MEDICARE: WENDOVER PRIMARY CARE CLINIC, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780053082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WENDOVER PRIMARY CARE CLINIC, PLLC

Provider Business Mailing Address
First Line	:	5109 MONROE RD STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7879
Country	:	US
Telephone Number	:	704-900-5194
Fax Number	:	833-974-2188

Provider Business Practice Location Address
First Line	:	5109 MONROE RD STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7878
Country	:	US
Telephone Number	:	704-364-4216
Fax Number	:	704-366-6391

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RENE CHIKE ANIKWUE
Credential	:	MD
Telephone Number	:	704-900-5194

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	12/10/2025

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