MEDICARE: CHARLES R. SLONE, M.D., P.C.

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	207RG0100X	Gastroenterology Physician	4301030744	MI

General Provider Information

NPI Number	:	1770889834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES R. SLONE, M.D., P.C.

Provider Business Mailing Address
First Line	:	2021 MONROE ST
Second Line	:	SUITE 201
City	:	DEARBORN
State	:	MI
Zip	:	48124-2926
Country	:	US
Telephone Number	:	313-565-9390
Fax Number	:	313-565-9544

Provider Business Practice Location Address
First Line	:	2021 MONROE ST
Second Line	:	SUITE 201
City	:	DEARBORN
State	:	MI
Zip	:	48124-2926
Country	:	US
Telephone Number	:	313-565-9390
Fax Number	:	313-565-9544

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES R SLONE
Credential	:	M.D.
Telephone Number	:	313-565-9390

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	05/20/2011

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