Provider Demographics
NPI:1639149610
Name:SLONE, CHARLES R (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:SLONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2021 MONROE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2926
Mailing Address - Country:US
Mailing Address - Phone:313-565-9390
Mailing Address - Fax:313-565-9544
Practice Address - Street 1:2021 MONROE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2926
Practice Address - Country:US
Practice Address - Phone:313-565-9390
Practice Address - Fax:313-565-9544
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2015-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MICS030744207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43831Medicare UPIN
MIB43831Medicare UPIN