Provider Demographics
NPI:1841229127
Name:RENICH, MICHAELA ELAINE (MD)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ELAINE
Last Name:RENICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-242-1228
Mailing Address - Fax:336-242-1393
Practice Address - Street 1:1926 COTTON GROVE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-5722
Practice Address - Country:US
Practice Address - Phone:336-242-1228
Practice Address - Fax:336-242-1393
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-01460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891187GMedicaid
NC891187GMedicaid
NC2263287BMedicare PIN