Individual
JOSEPH MATTHEW MICCHIA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10500 LIGON MILL RD, SUITE 113, WAKE FOREST, NC 27587-6090
(919) 570-5705
(919) 570-5710
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OS008793L
PA
207Q00000X
Family Medicine Physician
Primary
2005-01578
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011630849
—
PA
01
—
142W7
BCBS
NC
05
—
5905075
—
NC
Enumeration date
02/16/2006
Last updated
10/28/2020
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