Organization
LAKE NORMAN EARS NOSE AND THROAT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERBERT LEE WETTREICH MD (MD)
(704) 664-9368
Entity
Organization
Contact information
Practice address
140 GATEWAY BLVD, MOORESVILLE, NC 28117
(704) 664-9638
(704) 664-1859
Mailing address
140 GATEWAY BLVD, MOORESVILLE, NC 28117
(704) 664-9638
(704) 664-1859
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0270K
BCBS
NC
01
—
1781857
UNITED HEALTHCARE
NC
05
—
5912716
—
NC
05
—
8986676
—
NC
Enumeration date
07/10/2006
Last updated
12/09/2009
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