Provider Demographics
NPI:1104087659
Name:WETZEL, CHAD
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:WETZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 LEGACY PARK DR APT 5
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1359
Mailing Address - Country:US
Mailing Address - Phone:517-543-0691
Mailing Address - Fax:
Practice Address - Street 1:294 LEGACY PARK DR APT 5
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1359
Practice Address - Country:US
Practice Address - Phone:517-543-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI237999251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health