Basic Information
| Provider Information | |||||||||
| NPI: | 1982650735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARMEL FOOT SPECIALISTS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 S TORRENCE ST | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043348682 | ||||||||
| FaxNumber: | 7043340754 | ||||||||
| Practice Location | |||||||||
| Address1: | 717 S TORRENCE ST | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282043071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043348682 | ||||||||
| FaxNumber: | 7043340754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7043348682 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213EP1101X | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8908038 | 05 | NC | MEDICAID |