MEDICARE: DR. MICHELLE CONCETTE CHAMBERS 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
1	207N00000X	Dermatology Physician	35-06-0930C	OH

General Provider Information

NPI Number	:	1538152954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE CONCETTE CHAMBERS M.D.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9016
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	1830 BETHEL ROAD
Second Line	:	SUITE C
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1809
Country	:	US
Telephone Number	:	614-754-8781
Fax Number	:	614-754-8924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	02/15/2021

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