Basic Information
| Provider Information | |||||||||
| NPI: | 1376702522 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHAEL | ||||||||
| FirstName: | TESFALDET | ||||||||
| MiddleName: | TECLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042643500 | ||||||||
| FaxNumber: | 7044174989 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 MATTHEWS TOWNSHIP PKWY STE 212 | ||||||||
| Address2: | |||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281055403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043163131 | ||||||||
| FaxNumber: | 7043163132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2017-01806 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 2017-01806 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.