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General NPI Number Information
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NPI Number | 1710306741
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Entity Type | Individual
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Provider Name | JASON CHATMAN PA (ASCP)
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Gender | Male
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 15669 NORTHVILLE FOREST DR
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City | PLYMOUTH
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State | MI
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Zip | 48170-4905
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Country | US
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Telephone | 734-673-5608
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Fax |
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Provider Business Mailing Address
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Address Line | 15669 NORTHVILLE FOREST DR
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City | PLYMOUTH
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State | MI
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Zip | 48170-4905
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Country | US
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Telephone | 734-673-5608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 672
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License Number State | MI
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