Healthcare Provider Details

I. General information

NPI: 1720025166
Provider Name (Legal Business Name): CHADWICK A FURNESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 GRAND RIDGE CT NE SUITE 101
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

1787 GRAND RIDGE CT NE SUITE 101
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-8131
  • Fax: 616-774-8204
Mailing address:
  • Phone: 616-774-8131
  • Fax: 616-774-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301063885
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: