| NPI | 1457601601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN CHARLES MCDONALD Owner 704-786-4482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 443) |
| Additional Taxonomies | 213E00000X Podiatrist |
| 213ER0200X Podiatrist Radiology | |
| 213ES0103X Podiatrist Foot & Ankle Surgery | |
| 213ES0131X Podiatrist Foot Surgery | |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2018-09-28 |