Individual
KSHITIJ P MISTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 BLYTHE BLVD, MEDICAL CENTER PLAZA, SUITE 200, CHARLOTTE, NC 28203-5866
(704) 381-8840
(704) 381-8848
Mailing address
PO BOX 601372, CHARLOTTE, NC 28260-1372
(704) 381-8840
(704) 381-8848
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
2004-01098
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136VH
BCBS
NC
05
—
1548272107
—
NC
05
—
79136VH
—
NC
05
—
Q0109C
—
SC
Enumeration date
08/12/2006
Last updated
11/29/2016
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