Provider Demographics
NPI:1720025166
Name:FURNESS, CHADWICK A (MD)
Entity Type:Individual
Prefix:
First Name:CHADWICK
Middle Name:A
Last Name:FURNESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1787 GRAND RIDGE CT NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-774-8131
Mailing Address - Fax:616-774-8204
Practice Address - Street 1:1787 GRAND RIDGE CT NE
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-774-8131
Practice Address - Fax:616-774-8204
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301063885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080D17690OtherBLUE SHIELD
MI900000696OtherPRIORITY HEALTH
MI3351977Medicaid
MI5592515OtherAETNA
MI3351977Medicaid
MIG52962Medicare UPIN