Provider Demographics
NPI:1275612871
Name:CHIARA, LOUIS C (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:C
Last Name:CHIARA
Suffix:
Gender:M
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:PO BOX 930319
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393
Mailing Address - Country:US
Mailing Address - Phone:248-684-1282
Mailing Address - Fax:248-684-2485
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381
Practice Address - Country:US
Practice Address - Phone:248-684-1282
Practice Address - Fax:248-684-2485
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045542207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0706349011OtherBCBSM
MI4749920Medicaid
P19920001Medicare ID - Type Unspecified
B43486Medicare UPIN
0P19920Medicare ID - Type Unspecified