Organization
MEDICAL GROUP OF THE TRIAD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY KWIATKOWSKI MD (PRESIDENT)
(336) 242-1125
Entity
Organization
Contact information
Practice address
215 W US HIGHWAY 64, SUITE 1, LEXINGTON, NC 27295-2567
(336) 242-1125
Mailing address
215 W US HIGHWAY 64, SUITE 1, LEXINGTON, NC 27295-2567
(336) 242-1125
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285658906
NPI PERSONAL KRISTI MAULDIN
NC
01
—
1396910345
NPI INDIVIDUAL SHENOA RONDEAU
NC
01
—
1689661761
NPI INDIVIDUAL TIM KWIATKOWSKI
NC
Enumeration date
03/08/2016
Last updated
03/08/2016
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