Provider Demographics
NPI:1437329703
Name:KASSEM M CHARARA MD PC
Entity Type:Organization
Organization Name:KASSEM M CHARARA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KASSEM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHARARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-581-1222
Mailing Address - Street 1:6211 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2405
Mailing Address - Country:US
Mailing Address - Phone:313-581-1222
Mailing Address - Fax:313-581-6657
Practice Address - Street 1:6211 CHASE RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2405
Practice Address - Country:US
Practice Address - Phone:313-581-1222
Practice Address - Fax:313-581-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0826564OtherBLUE CROSS BLUE SHIELD
MI0826564OtherBLUE CROSS BLUE SHIELD
MIOM82440Medicare PIN
MIG75077Medicare UPIN