Individual
DAN M CHAFFEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 983-8300
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(317) 962-4343
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01040042A
IN
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
038079
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200019120
—
IN
05
—
4390530
—
MI
05
—
4748145
—
MI
05
—
4748154
—
MI
01
—
DC038079
BC/BS
MI
Enumeration date
06/17/2006
Last updated
01/19/2017
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