Provider Demographics
NPI:1316171630
Name:SOUTH CHARLOTTE CARDIOLOGY, P.C.
Entity type:Organization
Organization Name:SOUTH CHARLOTTE CARDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KULPREET
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-321-2741
Mailing Address - Street 1:PO BOX 472423
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-2423
Mailing Address - Country:US
Mailing Address - Phone:704-321-2741
Mailing Address - Fax:803-396-8232
Practice Address - Street 1:11220 ELM LN STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0450
Practice Address - Country:US
Practice Address - Phone:704-321-2741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200495207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty