Individual
DR. LANCE R. CHALDECOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2070 BIDDLE AVE, SUITE 200, WYANDOTTE, MI 48192-4080
(734) 225-9100
(734) 225-9100
Mailing address
1640 FORT ST, SUITE D ATTN DENISE, TRENTON, MI 48183-2040
(734) 391-3057
(734) 391-3052
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
4301061724
MI
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
4301061724
MI
207XX0801X
Orthopaedic Trauma Physician
4301061724
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H28427
BLUE CROSS
MI
05
—
104481368
—
MI
01
—
1699102244
GROUP NPI HENRY FORD WYANDOTTE
MI
Enumeration date
01/30/2006
Last updated
02/21/2017
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