Provider Demographics
NPI:1851583215
Name:TYRONE CHATMAN ETAL PTR MARTRILLA ROSS GEN PTR
Entity Type:Organization
Organization Name:TYRONE CHATMAN ETAL PTR MARTRILLA ROSS GEN PTR
Other - Org Name:ACUPUNCTURE TREATMENT CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTRILLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSS-CHATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-871-9940
Mailing Address - Street 1:17650 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1911
Mailing Address - Country:US
Mailing Address - Phone:313-871-9940
Mailing Address - Fax:
Practice Address - Street 1:17650 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1911
Practice Address - Country:US
Practice Address - Phone:313-871-9940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039079261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1851583215OtherNPI
MI1891701884OtherNPI
MIOM83260OtherMEDICARE