Provider Demographics
NPI:1568763795
Name:DESANTIS FAMILY PRACTICE
Entity Type:Organization
Organization Name:DESANTIS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-304-6363
Mailing Address - Street 1:10 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5044
Mailing Address - Country:US
Mailing Address - Phone:828-304-6363
Mailing Address - Fax:828-304-0033
Practice Address - Street 1:10 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5044
Practice Address - Country:US
Practice Address - Phone:828-304-6363
Practice Address - Fax:828-304-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7578132OtherCIGNA HEALTHCARE
NC7578132OtherCIGNA HEALTHCARE