Provider Demographics
NPI:1609047935
Name:STEPHEN G. CHASE, M.D., P.C.
Entity Type:Organization
Organization Name:STEPHEN G. CHASE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRGINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-773-0028
Mailing Address - Street 1:211 S CRAPO ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2961
Mailing Address - Country:US
Mailing Address - Phone:989-773-0028
Mailing Address - Fax:989-773-5198
Practice Address - Street 1:211 S CRAPO ST
Practice Address - Street 2:SUITE M
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2961
Practice Address - Country:US
Practice Address - Phone:989-773-0028
Practice Address - Fax:989-773-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISC049911207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0373766Medicare PIN
MIB44976Medicare UPIN