Organization
C R ALDERDICE D O
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ALDERDICE D.O. (PHYSICIAN)
(269) 982-1722
Entity
Organization
Contact information
Practice address
1906 LANGLEY AVE, SAINT JOSEPH, MI 49085-1739
(269) 982-1722
Mailing address
1906 LANGLEY AVE, SAINT JOSEPH, MI 49085-1739
(269) 982-1722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101008526
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1607063
—
MI
01
—
5083312
AETNA PIN
—
01
—
5110022
BLUE CROSS
MI
01
—
5110022
MEDICARE PTAN
—
Enumeration date
01/03/2011
Last updated
01/03/2011
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