Provider Demographics
NPI:1447423447
Name:CHILDRENS HEALTH CENTER
Entity Type:Organization
Organization Name:CHILDRENS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHWIKANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-581-2064
Mailing Address - Street 1:10326 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1659
Mailing Address - Country:US
Mailing Address - Phone:313-581-2064
Mailing Address - Fax:313-581-3590
Practice Address - Street 1:10326 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1659
Practice Address - Country:US
Practice Address - Phone:313-581-2064
Practice Address - Fax:313-581-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056496261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3508255982OtherBCBSM
MI700H219830OtherBLUE CARE NEWWORK
MI3180397Medicaid
MI3180397Medicaid