Provider Demographics
NPI:1689602971
Name:CHAMOT, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CHAMOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OLIN HEALTH CENTER
Mailing Address - Street 2:EAST CIRCLE DR
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1037
Mailing Address - Country:US
Mailing Address - Phone:517-884-6546
Mailing Address - Fax:
Practice Address - Street 1:107 OLIN HEALTH CENTER
Practice Address - Street 2:EAST CIRCLE DR
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1037
Practice Address - Country:US
Practice Address - Phone:517-353-5237
Practice Address - Fax:517-432-9528
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1375058Medicaid
MIC36019107Medicare PIN
MIC36019123Medicare PIN
MIF19368Medicare UPIN