Basic Information
| Provider Information | |||||||||
| NPI: | 1962477430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNLAP | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ADAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15109 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284085109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103922525 | ||||||||
| FaxNumber: | 9103922827 | ||||||||
| Practice Location | |||||||||
| Address1: | 1709 S 16TH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284016429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104528633 | ||||||||
| FaxNumber: | 9104528569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.