# MECKLENBURG MEDICAL GROUP

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

## Provider details

- **NPI number:** 1518282581
- **Authorized official:** DANIEL L WIENS (SENIOR VICE PRESIDENT OPERATIONS)
- **Authorized official phone:** (704) 355-0648

## Contact information

- **Practice address:** 7666 CHARLOTTE HIGHWAY, SUITE 200, INDIAN LAND, SC 29707-7001
- **Practice address phone:** (704) 302-9600
- **Practice address fax:** (803) 431-8225
- **Mailing address:** PO BOX 60063, CHARLOTTE, NC 28260-0063
- **Mailing address phone:** (704) 302-9600
- **Mailing address fax:** (803) 431-8225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/02/2010
- **Last updated:** 04/02/2010