Healthcare Provider Details

I. General information

NPI: 1194990275
Provider Name (Legal Business Name): R CHARLES MEDLAR, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S EAST AVE
JACKSON MI
49201-2412
US

IV. Provider business mailing address

PO BOX 600
JACKSON MI
49204-0600
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-3902
  • Fax: 517-787-8335
Mailing address:
  • Phone: 517-787-3902
  • Fax: 517-787-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36871
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERT CHARLES MEDLAR
Title or Position: PRESIDENT
Credential:
Phone: 517-787-4470