# MARK MICELI

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275693509
- **Authorized official:** DR. MARK MICELI D.P.M. (OWNER)
- **Authorized official phone:** (704) 547-0000

## Contact information

- **Practice address:** 8301 UNIVERSITY EXEC PARK DR STE 112, CHARLOTTE, NC 28262-3593
- **Practice address phone:** (704) 547-0000
- **Practice address fax:** (704) 547-0460
- **Mailing address:** 8301 UNIVERSITY EXEC PARK DR, SUITE 112, CHARLOTTE, NC 28262-1366
- **Mailing address phone:** (704) 547-0000
- **Mailing address fax:** (704) 547-0460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 302 | NC | Yes |

## Other

- **Enumeration date:** 12/08/2006
- **Last updated:** 02/14/2008