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NPI Code Detail

MEDICARE: CHANTAL I DALENCOUR MD

MEDICARE: CHANTAL I DALENCOUR MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician35073965OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2370017680OTHEROHRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265434120
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANTAL I DALENCOUR MD
Provider Business Mailing Address
First Line : 26908 DETROIT RD
Second Line : SUITE 301
City : WESTLAKE
State : OH
Zip : 44145-2398
Country : US
Telephone Number : 440-617-1823
Fax Number : 440-617-0884
Provider Business Practice Location Address
First Line : 34960 CENTER RIDGE RD
Second Line :
City : NORTH RIDGEVILLE
State : OH
Zip : 44039-3183
Country : US
Telephone Number : 440-353-3433
Fax Number : 440-353-3431
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 11/17/2020

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Directions to “ CHANTAL I DALENCOUR MD” Practice Location

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