Provider Demographics
NPI:1194859314
Name:CHIVALAK, DARAPEN C (MD)
Entity Type:Individual
Prefix:
First Name:DARAPEN
Middle Name:C
Last Name:CHIVALAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DARAPEN
Other - Middle Name:C
Other - Last Name:CHIVALAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2601 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-561-1691
Mailing Address - Fax:
Practice Address - Street 1:1640 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2913
Practice Address - Country:US
Practice Address - Phone:313-565-6208
Practice Address - Fax:313-565-4771
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDC031719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist