Provider Demographics
NPI:1083795132
Name:BINSTOCK, MICHAEL LASALA (PAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LASALA
Last Name:BINSTOCK
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1414 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7505
Mailing Address - Country:US
Mailing Address - Phone:910-763-7363
Mailing Address - Fax:910-251-8296
Practice Address - Street 1:1505 NORTHSIDE FORSYTH BLVD
Practice Address - Street 2:STE 3500
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004505363AS0400X
NC1000755363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ74972Medicare UPIN