MEDICARE: DR. RICHARD JORDAN CHALMERS D.O.

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	207Q00000X	Family Medicine Physician	5101017320	MI

General Provider Information

NPI Number	:	1619174505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JORDAN CHALMERS D.O.

Provider Business Mailing Address
First Line	:	36500 S GRATIOT AVE
Second Line	:	SUITE 202
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-1772
Country	:	US
Telephone Number	:	586-493-3727
Fax Number	:

Provider Business Practice Location Address
First Line	:	36500 S GRATIOT AVE
Second Line	:	SUITE 202
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-1772
Country	:	US
Telephone Number	:	586-493-3727
Fax Number	:

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	04/22/2014

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