Provider Demographics
NPI:1184489551
Name:RENAISSANCE PERFORMANCE MEDICINE PLLC
Entity type:Organization
Organization Name:RENAISSANCE PERFORMANCE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:980-242-2992
Mailing Address - Street 1:8045 PROVIDENCE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9724
Mailing Address - Country:US
Mailing Address - Phone:980-242-2992
Mailing Address - Fax:
Practice Address - Street 1:8045 PROVIDENCE RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9724
Practice Address - Country:US
Practice Address - Phone:980-242-2992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty