Individual
STEPHEN LEE WALLENHAUPT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1718 E 4TH ST, SUITE 701, CHARLOTTE, NC 28204-3261
(704) 316-5100
(704) 316-5101
Mailing address
1718 E 4TH ST, SUITE 701, CHARLOTTE, NC 28204-3261
(704) 316-5100
(704) 316-5101
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
26402
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8985522
—
NC
Enumeration date
07/20/2005
Last updated
07/08/2007
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