Provider Demographics
NPI:1013361799
Name:INFINITE WELLNESS OF THE CAROLINAS
Entity Type:Organization
Organization Name:INFINITE WELLNESS OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HIRENKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ITALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-792-2200
Mailing Address - Street 1:103 COUNTRY CLUB DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2935
Mailing Address - Country:US
Mailing Address - Phone:704-792-2200
Mailing Address - Fax:
Practice Address - Street 1:103 COUNTRY CLUB DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2935
Practice Address - Country:US
Practice Address - Phone:704-792-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty