Provider Demographics
NPI:1083830848
Name:CHALEM, MARK L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:CHALEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 31120
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3018
Mailing Address - Country:US
Mailing Address - Phone:509-319-9599
Mailing Address - Fax:509-315-8807
Practice Address - Street 1:3515 S LLOYD RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-1163
Practice Address - Country:US
Practice Address - Phone:509-319-9599
Practice Address - Fax:509-315-8807
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000177752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1077791Medicaid
WA0034878OtherL AND I
A07128Medicare UPIN