Healthcare Provider Details

I. General information

NPI: 1063774172
Provider Name (Legal Business Name): CHAD KENNETH CASE M.S., P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

IV. Provider business mailing address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1594
  • Fax: 517-205-1540
Mailing address:
  • Phone: 517-205-1594
  • Fax: 517-205-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006342
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006342
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: