Individual
MIGUEL ANGEL CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
192 WINDING CREEK DR, TROUTMAN, NC 28166-7677
(704) 495-1619
Mailing address
192 WINDING CREEK DR, TROUTMAN, NC 28166-7677
(704) 495-1619
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
000032581474
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40416415
—
NC
Enumeration date
05/19/2022
Last updated
05/19/2022
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