Provider Demographics
NPI:1326024498
Name:NACOUZI, MICHELE DUVAL (MD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DUVAL
Last Name:NACOUZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7021 HARPS MILL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3240
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:
Practice Address - Street 1:10211 ALM ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8221
Practice Address - Country:US
Practice Address - Phone:919-484-8345
Practice Address - Fax:919-419-8218
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC61907OtherBCBS
NC2210799BMedicare ID - Type Unspecified
NC71046Medicare UPIN