MEDICARE: MARK ANDREW HNILICA MD

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	207T00000X	Neurological Surgery Physician	35 082797	OH
2	207T00000X	Neurological Surgery Physician	9700588	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35 082797	OTHER	OH	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922091339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANDREW HNILICA MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-7840
Fax Number	:	704-384-7830

Provider Business Practice Location Address
First Line	:	190 KIMEL PARK DR STE 155
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6946
Country	:	US
Telephone Number	:	336-765-6637
Fax Number	:	336-765-6964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/05/2023

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Directions to “ MARK ANDREW HNILICA MD” Practice Location

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