Provider Demographics
NPI:1669443552
Name:CHALDECOTT, LANCE R (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:R
Last Name:CHALDECOTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:2070 BIDDLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4080
Practice Address - Country:US
Practice Address - Phone:734-225-9100
Practice Address - Fax:734-225-9100
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301061724207XS0114X, 207XX0801X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699102244OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H28427OtherBLUE CROSS
MI104481368Medicaid
MI104481368Medicaid
MI1699102244OtherGROUP NPI HENRY FORD WYANDOTTE