Provider Demographics
NPI:1417981010
Name:AMIN, KETAN BIPINCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:KETAN
Middle Name:BIPINCHANDRA
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 FAIRVIEW RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3113
Mailing Address - Country:US
Mailing Address - Phone:704-495-6324
Mailing Address - Fax:704-384-1704
Practice Address - Street 1:924 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3456
Practice Address - Country:US
Practice Address - Phone:704-800-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138CXMedicaid
NC1417981010Medicaid
SCN0116CMedicaid
SCN0116CMedicaid
NC2029261Medicare PIN
NCI19941Medicare UPIN
NC89138CXMedicaid
NC1417981010Medicaid
NCNCM872AMedicare PIN