Provider Demographics
NPI:1235431818
Name:LAKE NORMAN NEUROLOGY
Entity Type:Organization
Organization Name:LAKE NORMAN NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-662-3077
Mailing Address - Street 1:139 GATEWAY BLVD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5540
Mailing Address - Country:US
Mailing Address - Phone:704-662-3077
Mailing Address - Fax:704-662-3458
Practice Address - Street 1:139 GATEWAY BLVD
Practice Address - Street 2:SUITE 127
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5540
Practice Address - Country:US
Practice Address - Phone:704-662-3077
Practice Address - Fax:704-662-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty