# CHARLOTTE FOOT CLINIC

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

## Provider details

- **NPI number:** 1871524595
- **Authorized official:** MS. NANCY A TROUTMAN MOA (MOA INSURANCE PROCESSOR)
- **Authorized official phone:** (704) 394-4980

## Contact information

- **Practice address:** 4016 WILKINSON BLVD, STE A, CHARLOTTE, NC 28208
- **Practice address phone:** (704) 394-4980
- **Practice address fax:** (704) 392-8962
- **Mailing address:** 4016 WILKINSON BLVD, STE A, CHARLOTTE, NC 28208
- **Mailing address phone:** (704) 394-4980
- **Mailing address fax:** (704) 392-8962

## Taxonomy

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

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 06/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 012EJ | BCBS | — |