Provider Demographics
NPI:1174561310
Name:CHAILLET, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:CHAILLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 MACK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5300
Mailing Address - Country:US
Mailing Address - Phone:513-874-8111
Mailing Address - Fax:513-860-6992
Practice Address - Street 1:2960 MACK RD STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5300
Practice Address - Country:US
Practice Address - Phone:513-874-8111
Practice Address - Fax:513-860-6992
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2472720Medicaid
OHF08479Medicare UPIN