Provider Demographics
NPI:1629024112
Name:SETSER, CHARLES ADAM (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ADAM
Last Name:SETSER
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 1:36123 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:734-793-6140
Mailing Address - Fax:734-402-0254
Practice Address - Street 1:7073 CLYO RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4816
Practice Address - Country:US
Practice Address - Phone:937-435-5857
Practice Address - Fax:937-912-4960
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35- 07-6961207R00000X
KY49624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2239947Medicaid
OH4046034Medicare PIN
OH2239947Medicaid
SE4046035Medicare PIN
OH4046033Medicare PIN