Provider Demographics
NPI:1578054573
Name:EL MOKDAD, CHIRINE (MD)
Entity Type:Individual
Prefix:
First Name:CHIRINE
Middle Name:
Last Name:EL MOKDAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7188 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1571
Mailing Address - Country:US
Mailing Address - Phone:248-625-1600
Mailing Address - Fax:248-625-0239
Practice Address - Street 1:7188 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1571
Practice Address - Country:US
Practice Address - Phone:248-625-1600
Practice Address - Fax:248-625-0239
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301115270207R00000X
MI4301505066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine