Provider Demographics
NPI:1770889834
Name:CHARLES R. SLONE, M.D., P.C.
Entity type:Organization
Organization Name:CHARLES R. SLONE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-565-9390
Mailing Address - Street 1:2021 MONROE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2926
Mailing Address - Country:US
Mailing Address - Phone:313-565-9390
Mailing Address - Fax:313-565-9544
Practice Address - Street 1:2021 MONROE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2926
Practice Address - Country:US
Practice Address - Phone:313-565-9390
Practice Address - Fax:313-565-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030744207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43831Medicare UPIN