Individual
KATHLEEN WUNDER PERSAVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2400 SOUTH BLVD STE 103, CHARLOTTE, NC 28203-5773
(704) 316-3000
(704) 316-3001
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-3000
(704) 316-3001
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
157376
NC
207V00000X
Obstetrics & Gynecology Physician
Primary
2013-00887
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689808123
—
NC
Enumeration date
05/13/2009
Last updated
05/26/2022
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