Provider Demographics
NPI:1740220870
Name:CHADWICK, ROBERT L (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:CHADWICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 S MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1692
Mailing Address - Country:US
Mailing Address - Phone:989-502-1122
Mailing Address - Fax:989-502-1212
Practice Address - Street 1:154 S MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1692
Practice Address - Country:US
Practice Address - Phone:989-502-1122
Practice Address - Fax:989-502-1212
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007818207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225547383OtherGROUP NPI
MI4850686Medicaid