Organization
MECKLENBURG MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL WIENS (SR. VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
13640 STEELECROFT PARKWAY, SUITE 320, CHARLOTTE, NC 28278-7565
(704) 302-8900
(704) 302-8901
Mailing address
PO BOX 60063, CHARLOTTE, NC 28260-0063
(704) 512-4808
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/05/2009
Last updated
11/05/2009
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