Organization
CHANGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOLITA CHANDLER (GENERAL PARTNER)
(313) 368-0005
Entity
Organization
Contact information
Practice address
19940 CONANT ST, DETROIT, MI 48234-1494
(313) 368-0005
(313) 368-0771
Mailing address
19940 CONANT ST, DETROIT, MI 48234-1494
(313) 368-0005
(313) 368-0771
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
SA0823210
MI
251B00000X
Case Management Agency
—
—
261QM2800X
Methadone Clinic
Primary
SA0823210
MI
Other
Enumeration date
07/30/2014
Last updated
07/30/2014
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up