Provider Demographics
NPI:1538152954
Name:CHAMBERS, MICHELLE CONCETTE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CONCETTE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9016
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1830 BETHEL ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1809
Practice Address - Country:US
Practice Address - Phone:614-754-8781
Practice Address - Fax:614-754-8924
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-0930C207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH0694152Medicare PIN
OH03-00454OtherUNITED HEALTHCARE PROVIDE
OH4208616OtherAETNA INS. PROVIDER NUMBE
OH070016242Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH38660268015OtherMED. MUTUAL PROV #
OH0000000122935OtherBC/BS PROVIDER #
OH2445121009OtherCIGNA PROVIDER #
OHE16077Medicare UPIN