Healthcare Provider Details

I. General information

NPI: 1871699371
Provider Name (Legal Business Name): MARIO CHAVES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W KING ST SUITE 103
OWOSSO MI
48867-2116
US

IV. Provider business mailing address

818 W KING ST SUITE 103
OWOSSO MI
48867-2116
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4300
  • Fax: 989-729-4303
Mailing address:
  • Phone: 989-729-4300
  • Fax: 989-729-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301086974
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704234443
License Number StateMI

VIII. Authorized Official

Name: DR. CESAR MARIO CHAVES
Title or Position: PHYSICIAN PROPRIETOR
Credential: MD
Phone: 989-729-4300