Provider Demographics
NPI:1891809893
Name:MICHAEL CHRISTOPHER DESANTIS
Entity Type:Organization
Organization Name:MICHAEL CHRISTOPHER DESANTIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
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 1:608 46TH AVENUE DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7318
Mailing Address - Country:US
Mailing Address - Phone:828-304-6363
Mailing Address - Fax:828-304-0033
Practice Address - Street 1:608 46TH AVENUE DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-7318
Practice Address - Country:US
Practice Address - Phone:828-320-2972
Practice Address - Fax:828-465-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1190COtherBCBS
NC89-1190CMedicaid
NCDC4226OtherMEDICARE RAILROAD
NCDC4226OtherMEDICARE RAILROAD
NC2335677Medicare ID - Type Unspecified