Healthcare Provider Details

I. General information

NPI: 1184702219
Provider Name (Legal Business Name): MARSHA L. CHAFFINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM 3031 WEST GRAND BLVD.
DETROIT MI
48202
US

IV. Provider business mailing address

HENRY FORD HEALTH SYSTEM 3031 WEST GRAND BLVD.
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2454
  • Fax:
Mailing address:
  • Phone: 313-916-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number054211
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: