MEDICARE: JAMES RICHARD CHENOWETH 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
1	207Q00000X	Family Medicine Physician	4301043932	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080813885	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902863020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RICHARD CHENOWETH MD

Provider Business Mailing Address
First Line	:	4335 JACKSON RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103
Country	:	US
Telephone Number	:	734-996-5529
Fax Number	:	734-996-2757

Provider Business Practice Location Address
First Line	:	4335 JACKSON RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-1831
Country	:	US
Telephone Number	:	734-996-5529
Fax Number	:	734-996-2757

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	10/17/2011

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