Provider Demographics
NPI:1376629287
Name:CHANDLER, JERRY J (DO)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:J
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2248 MOUNT HOPE RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2501
Mailing Address - Country:US
Mailing Address - Phone:517-482-1183
Mailing Address - Fax:517-482-9877
Practice Address - Street 1:2248 MOUNT HOPE RD
Practice Address - Street 2:STE. 100
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2501
Practice Address - Country:US
Practice Address - Phone:517-482-1183
Practice Address - Fax:517-482-9877
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1112119Medicaid
MIE-26035Medicare UPIN