Provider Demographics
NPI:1821198003
Name:CHARBONIER, DEL (MD)
Entity Type:Individual
Prefix:
First Name:DEL
Middle Name:
Last Name:CHARBONIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27101 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4730
Mailing Address - Country:US
Mailing Address - Phone:586-758-5800
Mailing Address - Fax:586-758-5841
Practice Address - Street 1:27101 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4730
Practice Address - Country:US
Practice Address - Phone:586-758-5800
Practice Address - Fax:586-758-5841
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDC049752OtherBLUE CROSS BLUE SHIELD
MI1988470Medicaid
MI1105015482OtherBCBSMI PIN
MI1105015482OtherBCBSMI PIN
MI1988470Medicaid
MIA75999Medicare UPIN
MIP06950001Medicare PIN