Provider Demographics
NPI:1124621198
Name:LAKE NORMAN BARIATRICS
Entity type:Organization
Organization Name:LAKE NORMAN BARIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-402-2506
Mailing Address - Street 1:108 ALEXANDER BANK DR
Mailing Address - Street 2:SUITE 232
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-660-4584
Mailing Address - Fax:
Practice Address - Street 1:108 ALEXANDER BANK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-660-4584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy