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General NPI Number Information
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NPI Number | 1871699371
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Entity Type | Organization
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Legal Business Name | MARIO CHAVES PC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 818 W KING ST SUITE 103
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City | OWOSSO
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State | MI
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Zip | 48867-2116
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Country | US
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Telephone | 989-729-4300
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Fax | 989-729-4303
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Provider Business Mailing Address
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Address Line | 818 W KING ST SUITE 103
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City | OWOSSO
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State | MI
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Zip | 48867-2116
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Country | US
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Telephone | 989-729-4300
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Fax | 989-729-4303
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Authorized Official
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Title or Position | PHYSICIAN PROPRIETOR
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Name | DR. CESAR MARIO CHAVES
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Credential | MD
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Telephone | 989-729-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 4704234443
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301086974
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License Number State | MI
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