Provider Demographics
NPI:1629496237
Name:ANSOK, CHASE BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:BRADLEY
Last Name:ANSOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:311 MACK AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2466
Mailing Address - Country:US
Mailing Address - Phone:313-832-0500
Mailing Address - Fax:313-966-8400
Practice Address - Street 1:311 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2466
Practice Address - Country:US
Practice Address - Phone:313-832-0500
Practice Address - Fax:313-966-8400
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY297701207X00000X
MI4301502153207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery