Healthcare Provider Details

I. General information

NPI: 1528699485
Provider Name (Legal Business Name): SADDIE CHIARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 EAGLE PARK DR NE STE 100
GRAND RAPIDS MI
49525-4574
US

IV. Provider business mailing address

3310 EAGLE PARK DR NE STE 100
GRAND RAPIDS MI
49525-4574
US

V. Phone/Fax

Practice location:
  • Phone: 616-825-5482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6801097295
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: