Provider Demographics
NPI:1235181876
Name:MOK, CHARLES D (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:MOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:8180 26 MILE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5139
Mailing Address - Country:US
Mailing Address - Phone:586-992-8300
Mailing Address - Fax:586-992-9331
Practice Address - Street 1:8180 26 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5129
Practice Address - Country:US
Practice Address - Phone:586-786-5900
Practice Address - Fax:586-992-9331
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010912208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI201981170OtherWAUSAU INS CO
MI010E018410OtherBCBSM
MI5148205OtherAETNA
MI201981170OtherHARRINGTON BENEFITS
MI5148205OtherAETNA
MI201981170OtherAMERICAN MEDICAL SECURITY
MI201981170OtherWAUSAU INS CO