1952623787 NPI number — CHAIRAT CHOMCHAI M.D P.C

Table of content: (NPI 1952623787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952623787 NPI number — CHAIRAT CHOMCHAI M.D P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAIRAT CHOMCHAI M.D P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952623787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28111 HOOVER RD
Provider Second Line Business Mailing Address:
SUITE 6A
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48093-4153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-751-4230
Provider Business Mailing Address Fax Number:
586-751-9260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28111 HOOVER RD
Provider Second Line Business Practice Location Address:
SUITE 6A
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093-4153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-751-4230
Provider Business Practice Location Address Fax Number:
586-751-9260
Provider Enumeration Date:
02/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHOMCHAI
Authorized Official First Name:
CHAIRAT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-751-4230

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  4301032652 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0507655 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com