Provider Demographics
NPI:1376603407
Name:CHAMDIN, AGHIAD (MD)
Entity Type:Individual
Prefix:
First Name:AGHIAD
Middle Name:
Last Name:CHAMDIN
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 1:3901 BEAUBIEN BLVD, DETROIT, MI 48201
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48102
Mailing Address - Country:US
Mailing Address - Phone:313-745-5515
Mailing Address - Fax:313-745-5237
Practice Address - Street 1:3901 BEAUBIEN BLVD
Practice Address - Street 2:PEDIATRIC HEM ONC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5515
Practice Address - Fax:313-745-5237
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010663052080P0207X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376603407Medicaid
MI1376603407Medicaid