Basic Information
Provider Information
NPI: 1982040374
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAPPE
FirstName: ELIZABETH
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10850 E TRAVERSE HWY
Address2: SUITE 4400
City: TRAVERSE CITY
State: MI
PostalCode: 496841364
CountryCode: US
TelephoneNumber: 2313466930
FaxNumber: 2313466017
Practice Location
Address1: 1105 SIXTH ST
Address2:  
City: TRAVERSE CITY
State: MI
PostalCode: 496842349
CountryCode: US
TelephoneNumber: 2319355000
FaxNumber: 2313466017
Other Information
ProviderEnumerationDate: 05/13/2013
LastUpdateDate: 08/31/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XR73864AZY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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