MEDICARE: DR. PETER CARMEN CHIARAVALLI DDS

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	1223G0001X	General Practice Dentistry	10112	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952380412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER CARMEN CHIARAVALLI DDS

Provider Business Mailing Address
First Line	:	1500 W SAGINAW ST
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48915-1380
Country	:	US
Telephone Number	:	517-485-5738
Fax Number	:	517-485-0169

Provider Business Practice Location Address
First Line	:	1500 W SAGINAW ST
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48915-1380
Country	:	US
Telephone Number	:	517-485-5738
Fax Number	:	517-485-0169

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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