Individual
TINA PETOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8220 UNIVERSITY EXEC PARK DR, SUITE 107, CHARLOTTE, NC 28262-3380
(704) 548-1221
(704) 548-1311
Mailing address
8220 UNIVERSITY EXEC PARK DR, STE 107, CHARLOTTE, NC 28262-3380
(704) 548-1221
(704) 548-1311
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
32417
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8967234
—
NC
Enumeration date
02/03/2006
Last updated
10/02/2007
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