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Organization
MECKLENBURG FOOT & ANKLE ASSOCIATES AND DIABETIC FOOT CLINIC PC
Active
Organization
MECKLENBURG FOOT & ANKLE ASSOCIATES AND DIABETIC FOOT CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT MITCHELL LIESMAN DPM (PRESIDENT, OWNER)
(704) 442-8433
Entity
Organization
Contact information
Practice address
2115 E 7TH ST STE 102, CHARLOTTE, NC 28204-3300
(704) 442-8433
(704) 817-9957
Mailing address
2115 E 7TH ST STE 102, CHARLOTTE, NC 28204-3300
(704) 442-8433
(704) 817-9957
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
NULL
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
356
NC
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0268L
GROUP NUMBER
NC
05
—
890268L
—
NC
Enumeration date
03/06/2007
Last updated
11/21/2018
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