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NPI Code Detail

MEDICARE: DR. EUGENE N CHARDOUL M.D.

MEDICARE: DR. EUGENE N CHARDOUL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician4301023744MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20B50683OTHERMIBCBS
3EC023744OTHERMISTATE LIC #

General Provider Information

NPI Number : 1154360378
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EUGENE N CHARDOUL M.D.
Provider Business Mailing Address
First Line : PO BOX 44047
Second Line :
City : DETROIT
State : MI
Zip : 48244-0047
Country : US
Telephone Number : 810-820-8121
Fax Number : 810-820-8335
Provider Business Practice Location Address
First Line : 3499 S LINDEN RD
Second Line : SUITE 2
City : FLINT
State : MI
Zip : 48507-3022
Country : US
Telephone Number : 810-820-8121
Fax Number : 810-820-8335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 10/10/2011

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