Provider Demographics
NPI:1477522381
Name:DIAB, CHAKER H (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAKER
Middle Name:H
Last Name:DIAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29703 HOOVER RD
Mailing Address - Street 2:STE A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-8901
Mailing Address - Country:US
Mailing Address - Phone:586-558-4081
Mailing Address - Fax:586-558-4099
Practice Address - Street 1:29703 HOOVER RD
Practice Address - Street 2:STE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-8901
Practice Address - Country:US
Practice Address - Phone:586-558-4081
Practice Address - Fax:586-558-4099
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICD012050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01338OtherBCBSM
MI4434081 11Medicaid
MI5435623OtherAETNA
MI1211664OtherFIRST HEALTH
MI320018015OtherCARE CHOICES
MIG75492OtherHEALTH ALLIANCE PLAN
MI5435623OtherAETNA
MIG75492Medicare UPIN