Provider Demographics
NPI:1013194182
Name:MANUEL R CHAVARRI, MD, PLLC
Entity Type:Organization
Organization Name:MANUEL R CHAVARRI, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAVARRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACE
Authorized Official - Phone:989-657-2925
Mailing Address - Street 1:108 S FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2812
Mailing Address - Country:US
Mailing Address - Phone:989-354-8500
Mailing Address - Fax:989-354-8200
Practice Address - Street 1:108 S FIRST AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2812
Practice Address - Country:US
Practice Address - Phone:989-354-8500
Practice Address - Fax:989-354-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMC034224261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P56870OtherMEDICARE PTAN
MI1923054Medicaid
MIMC034224OtherSTATE MEDICAL LICENSE
MI1100410341OtherBCBSM INDIVIDUAL #
MI1033102132OtherPERSONAL NPI FOR MANUEL R. CHAVARRI, MD, FACE
MI1100410711OtherBCBSM NEW PIN
MI0P56870OtherMEDICARE PTAN