Provider Demographics
NPI:1457335226
Name:CHAVES, CESAR MARIO (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:MARIO
Last Name:CHAVES
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 1:818 W KING ST STE LL
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2116
Mailing Address - Country:US
Mailing Address - Phone:989-729-4292
Mailing Address - Fax:989-725-9012
Practice Address - Street 1:818 W KING ST STE LL
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2116
Practice Address - Country:US
Practice Address - Phone:989-729-4292
Practice Address - Fax:989-725-9012
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457335226Medicaid
MI1457335226Medicaid
MIN53550053Medicare PIN