Provider Demographics
NPI:1174180327
Name:CHUCHULO, ANASTASYA (MD)
Entity Type:Individual
Prefix:MS
First Name:ANASTASYA
Middle Name:
Last Name:CHUCHULO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BACHMAN DR.
Mailing Address - Street 2:
Mailing Address - City:MAPLE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L6A3V7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 ANTOINE, STREET, DETROIT MEDICAL CENTER
Practice Address - Street 2:MICHAEL AND MARIAN ILLITCH DEPARTMENT OF SURGERY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:647-774-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2020-03-03
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-03-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program