Provider Demographics
NPI:1407836653
Name:CHAVEY, RUSSELL C (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:C
Last Name:CHAVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:42645 GARFIELD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5022
Mailing Address - Country:US
Mailing Address - Phone:586-286-0050
Mailing Address - Fax:586-286-0880
Practice Address - Street 1:42645 GARFIELD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5022
Practice Address - Country:US
Practice Address - Phone:586-286-0050
Practice Address - Fax:586-286-0880
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4310142875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4373665Medicaid
MIA73707Medicare UPIN
MI4373665Medicaid
MIN40170016Medicare ID - Type UnspecifiedMEDICARE