Provider Demographics
NPI:1730265760
Name:MISSOV, EMIL D (MD)
Entity type:Individual
Prefix:DR
First Name:EMIL
Middle Name:D
Last Name:MISSOV
Suffix:
Gender:M
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 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 HEART DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8982
Practice Address - Country:US
Practice Address - Phone:252-744-4400
Practice Address - Fax:252-744-3987
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44767207RC0000X
NC2024-00170207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0065399Medicaid
25-00021OtherMEDICA PRIMARY
25-01133OtherMEDICA CHOICE
171943OtherUCARE
WI34432300Medicaid
IA0568568Medicaid
MN968101900Medicaid
2032914OtherARAZ
1034881OtherPREFERRED ONE
HP40036OtherHEALTH PARTNERS
WI34432300Medicaid
1034881OtherPREFERRED ONE
H97590Medicare UPIN