Provider Demographics
NPI:1720826076
Name:HUMES, CHAD M SR
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:M
Last Name:HUMES
Suffix:SR
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 1:3327 WISCASSET RD
Mailing Address - Street 2:103
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1144
Mailing Address - Country:US
Mailing Address - Phone:313-401-1932
Mailing Address - Fax:
Practice Address - Street 1:3327 WISCASSET RD APT 103
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1144
Practice Address - Country:US
Practice Address - Phone:313-401-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH520115590047343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)