Provider Demographics
NPI:1467121327
Name:CHINCHAK, KATIE LOUISE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LOUISE
Last Name:CHINCHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LOUISE
Other - Last Name:CHINCHAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 HERITAGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3047
Mailing Address - Country:US
Mailing Address - Phone:734-767-2250
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:1 HERITAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3047
Practice Address - Country:US
Practice Address - Phone:734-767-2250
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist