Provider Demographics
NPI:1871570846
Name:CHAVEZ, ANNETTE M (MD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:CHAVEZ
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 1:2501 S DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1523
Mailing Address - Country:US
Mailing Address - Phone:937-643-3083
Mailing Address - Fax:
Practice Address - Street 1:2501 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-1523
Practice Address - Country:US
Practice Address - Phone:937-643-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0664035Medicaid
OH0664035Medicaid
OHA17318Medicare UPIN