Provider Demographics
NPI:1487735494
Name:CABARRUS PODIATRY ASSOCIATES PC
Entity type:Organization
Organization Name:CABARRUS PODIATRY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-788-1142
Mailing Address - Street 1:851 BRADLEY STREET
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-788-1142
Mailing Address - Fax:704-782-7912
Practice Address - Street 1:851 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2979
Practice Address - Country:US
Practice Address - Phone:704-788-1142
Practice Address - Fax:704-782-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487735494OtherNPI
NC7908022Medicaid
NC5390600001Medicare NSC
NC2346108Medicare PIN
NC7908022Medicaid