Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 4301034224 | MI |
NPI | 1033102132 |
---|---|
Provider Name | Manuel Chavarri |
First Address | Alpena, MI 49707-2929 |
Second Address | Alpena, MI 49707-1374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 22/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110026567 | RR MEDICARE (01) | MI |
1100410341 | BCBSM INDIVIDUAL # (01) | MI |
1100410711 | BCBSM NEW PIN (01) | MI |
1923054 | (05) | MI |
B46059 | (02) | MI |
MC034224 | STATE LICENSE (01) | MI |
P5687001 | MEDICARE PTAN (01) | MI |