Healthcare Provider Details

I. General information

NPI: 1174561310
Provider Name (Legal Business Name): JAMES CHAILLET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 MACK RD STE 201
FAIRFIELD OH
45014-5300
US

IV. Provider business mailing address

2960 MACK RD STE 201
FAIRFIELD OH
45014-5300
US

V. Phone/Fax

Practice location:
  • Phone: 513-874-8111
  • Fax: 513-860-6992
Mailing address:
  • Phone: 513-874-8111
  • Fax: 513-860-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35080537
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: