Provider Demographics
NPI:1003865874
Name:CHEN, MIMI (DO)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28585 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4330
Mailing Address - Country:US
Mailing Address - Phone:586-573-6910
Mailing Address - Fax:586-573-6746
Practice Address - Street 1:28585 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4330
Practice Address - Country:US
Practice Address - Phone:586-573-6910
Practice Address - Fax:586-573-6746
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011078207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4178366Medicaid
MI4178357Medicaid
MIG14662Medicare UPIN
MI4178357Medicaid