Provider Demographics
NPI:1366476517
Name:JOE S. CHOMCHAI, M.D., P.C.
Entity Type:Organization
Organization Name:JOE S. CHOMCHAI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHOMCHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-772-6848
Mailing Address - Street 1:2981 HEALTH PARKWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-772-6848
Mailing Address - Fax:989-772-6817
Practice Address - Street 1:2981 HEALTH PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-6848
Practice Address - Fax:989-772-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063374207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4337981Medicaid
MI4645845Medicaid
MI0N98860Medicare ID - Type Unspecified
MI4645845Medicaid