Provider Demographics
NPI:1457464174
Name:CHAPMAN, JEFFERY EARL (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:EARL
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36475 5 MILE RD
Mailing Address - Street 2:EMERGENCY DEPT.
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1971
Mailing Address - Country:US
Mailing Address - Phone:734-655-1200
Mailing Address - Fax:734-655-1270
Practice Address - Street 1:36475 5 MILE RD
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-655-1200
Practice Address - Fax:734-655-1270
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014191207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4579614Medicaid
MI4579614Medicaid