Provider Demographics
NPI:1790408672
Name:MEDLEA, CHANDLER
Entity Type:Individual
Prefix:MR
First Name:CHANDLER
Middle Name:
Last Name:MEDLEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13711 OAKBROOK DR APT 102
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4625
Mailing Address - Country:US
Mailing Address - Phone:216-213-4133
Mailing Address - Fax:
Practice Address - Street 1:13711 OAKBROOK DR APT 102
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4625
Practice Address - Country:US
Practice Address - Phone:216-213-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)