Organization
DEARK MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EFEMWONKIEKIE WILLIAM IYAMU MD (PRESIDENT/CEO)
(913) 302-1470
Entity
Organization
Contact information
Practice address
3719 LATROBE DR STE 840, CHARLOTTE, NC 28211-5121
(913) 302-1470
Mailing address
3719 LATROBE DR STE 840, CHARLOTTE, NC 28211-5121
(913) 302-1470
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2016-01529
NC
261QC1500X
Community Health Clinic/Center
—
—
261QM1000X
Migrant Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
03/08/2018
Last updated
02/06/2019
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