Provider Demographics
NPI:1417922030
Name:CHAPEL, JOHANNA (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:CHAPEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48123-2580
Mailing Address - Country:US
Mailing Address - Phone:313-561-5311
Mailing Address - Fax:313-561-2504
Practice Address - Street 1:2814 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3473
Practice Address - Country:US
Practice Address - Phone:313-561-5311
Practice Address - Fax:313-561-2504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039442207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0708223081OtherBCBS
MI1822913Medicare ID - Type Unspecified
A76051Medicare UPIN