Individual
DR. CHARLES RAY ALDERDICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1906 LANGLEY AVE, SAINT JOSEPH, MI 49085-1739
(269) 982-1722
(269) 982-1842
Mailing address
1906 LANGLEY AVE, SAINT JOSEPH, MI 49085-1739
(269) 982-1722
(269) 982-1842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101008526
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010012749
MRRR
MI
01
—
015110022
BS
MI
01
—
134870500
USDEP
MI
05
—
1607063
—
MI
01
—
382531804
TRICA
MI
Enumeration date
05/02/2006
Last updated
07/01/2010
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