1023009057 NPI number — MICHAEL C CHAMES M.D.

Table of content: MICHAEL C CHAMES M.D. (NPI 1023009057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023009057 NPI number — MICHAEL C CHAMES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMES
Provider First Name:
MICHAEL
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023009057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 LAURENCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49202-2964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-787-0364
Provider Business Mailing Address Fax Number:
517-787-2272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 LAURENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-787-0364
Provider Business Practice Location Address Fax Number:
517-787-2272
Provider Enumeration Date:
10/31/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MC057919 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)