Provider Demographics
NPI:1003803412
Name:DAHAN, CHAKER (MD)
Entity Type:Individual
Prefix:
First Name:CHAKER
Middle Name:
Last Name:DAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:DAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6833 VALHALLA WAY
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5627
Mailing Address - Country:US
Mailing Address - Phone:321-231-6795
Mailing Address - Fax:407-217-5856
Practice Address - Street 1:6833 VALHALLA WAY
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5627
Practice Address - Country:US
Practice Address - Phone:321-231-6795
Practice Address - Fax:407-217-5856
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30723207R00000X
FLME74515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4629OtherBCBS
F51099Medicare UPIN
FL46290RMedicare PIN
KY00280114Medicare PIN