Provider Demographics
NPI:1780610394
Name:DESANTIS, MICHAEL CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:828-304-6363
Practice Address - Fax:828-304-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2020-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC98-00233207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891144XMedicaid
NCF65290Medicare UPIN