Basic Information
| Provider Information | |||||||||
| NPI: | 1083795132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BINSTOCK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LASALA | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107637363 | ||||||||
| FaxNumber: | 9102518296 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 NORTHSIDE FORSYTH BLVD | ||||||||
| Address2: | STE 3500 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702926500 | ||||||||
| FaxNumber: | 7702926535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 004505 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | 1000755 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.