Provider Demographics
NPI:1720075955
Name:HARDEE, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:HARDEE
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 1:444 WILLIAMSON ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-658-9779
Mailing Address - Fax:704-658-9773
Practice Address - Street 1:444 WILLIAMSON ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-658-9779
Practice Address - Fax:704-658-9773
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02629OtherBLUE CROSS BLUE SHEILD
NC3974316OtherCIGNA
NC891267WMedicaid
NC2281030OtherMEDICARE PTAN
NC2281030OtherMEDICARE PTAN