Provider Demographics
NPI:1720161011
Name:AMIRI, MICHAEL M (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:AMIRI
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 1:70 LAKE CONCORD RD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3057
Mailing Address - Country:US
Mailing Address - Phone:980-777-8311
Mailing Address - Fax:980-777-8274
Practice Address - Street 1:3541 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1082
Practice Address - Country:US
Practice Address - Phone:704-335-9794
Practice Address - Fax:704-332-2329
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002001972084S0012X
NC1091772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891330HMedicaid
2004035Medicare ID - Type Unspecified
NC891330HMedicaid