Provider Demographics
NPI:1639826753
Name:CHRONIC DISEASE MANAGEMENT
Entity Type:Organization
Organization Name:CHRONIC DISEASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-405-0440
Mailing Address - Street 1:49560 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2524
Mailing Address - Country:US
Mailing Address - Phone:586-405-0440
Mailing Address - Fax:
Practice Address - Street 1:49560 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2524
Practice Address - Country:US
Practice Address - Phone:586-405-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRONIC DISEASE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty