Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101015653 | MI |
N | 207Q00000X | Family Doctor | 5101015653 | MI |
NPI | 1508088568 |
---|---|
Provider Name | Dr. Lynne M Chadfield |
First Address | Grand Rapids, MI 49501-3140 |
Second Address | Grand Rapids, MI 49546-8417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 06/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5101015653 | PHYSICIAN LICENSE NO. (01) | MI |
5315019040 | BOARD OF PHARMACY CONTROL (01) | MI |
5321251 | (05) | MI |