1134413040 NPI number — MR. MICHAEL PETER KONTAXES RPH

Table of content: MR. MICHAEL PETER KONTAXES RPH (NPI 1134413040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134413040 NPI number — MR. MICHAEL PETER KONTAXES RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONTAXES
Provider First Name:
MICHAEL
Provider Middle Name:
PETER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134413040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11560 UNIT 13
Provider Second Line Business Mailing Address:
NC HWY 55
Provider Business Mailing Address City Name:
GRANTSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-745-3911
Provider Business Mailing Address Fax Number:
252-745-1223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11560 UNIT 13
Provider Second Line Business Practice Location Address:
NC HWY 55
Provider Business Practice Location Address City Name:
GRANTSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-745-3911
Provider Business Practice Location Address Fax Number:
252-745-1223
Provider Enumeration Date:
06/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  17372 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com