Sergio Chavez
Individual provider Active NPI Driver · Grand Rapids, MI
NPI 1376304154 · NPPES record last updated Jan 19, 2024
Key facts
- NPI
- 1376304154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 40 Pearl St NW Ste 200
Grand Rapids, MI 49503-3026 - Phone
- (616) 204-7006
- NPI assigned
- Jan 19, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
40 Pearl St NW Ste 200
Grand Rapids, MI 49503-3026
Mailing address
40 Pearl St NW Ste 200
Grand Rapids, MI 49503-3026
Phone (616) 204-7006
Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.