MEDICARE: DR. MARC CHICOREL

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	5901001029	MI

General Provider Information

NPI Number	:	1629182357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC CHICOREL

Provider Business Mailing Address
First Line	:	6195 CARROLL DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6195 CARROLL DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2225
Country	:	US
Telephone Number	:	248-737-2262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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