Provider Demographics
NPI:1073008017
Name:BOONE, CHANTAL BERNADETTE-YOUSIF (DO)
Entity Type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:BERNADETTE-YOUSIF
Last Name:BOONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 LEAHY ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5542
Mailing Address - Country:US
Mailing Address - Phone:231-672-7800
Mailing Address - Fax:231-672-7801
Practice Address - Street 1:1675 LEAHY ST STE 201A
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5542
Practice Address - Country:US
Practice Address - Phone:231-672-7800
Practice Address - Fax:231-672-7801
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315094288390200000X
MI5101024275390200000X
AZ009068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program