Provider Demographics
NPI:1568423986
Name:CHOMCHAI, JOE S (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:S
Last Name:CHOMCHAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4851 E PICKARD ST STE 2700
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2042
Mailing Address - Country:US
Mailing Address - Phone:989-772-6848
Mailing Address - Fax:989-317-9263
Practice Address - Street 1:4851 E PICKARD ST STE 2700
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2042
Practice Address - Country:US
Practice Address - Phone:989-772-6848
Practice Address - Fax:989-317-9263
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063374207YX0905X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI040016591OtherPALMETTO GBA
MI4645845Medicaid
MI000370081OtherBCBSM
MI4337981Medicaid
MIH04421Medicare UPIN
MI040016591OtherPALMETTO GBA