Provider Demographics
NPI:1629023924
Name:CHURBAJI, HICHAM (MD)
Entity Type:Individual
Prefix:
First Name:HICHAM
Middle Name:
Last Name:CHURBAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 CHRISTY WAY
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2267
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:2137 W M 61
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-8463
Practice Address - Country:US
Practice Address - Phone:989-426-9399
Practice Address - Fax:989-246-2257
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHC065531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629023924Medicaid
MI383567566100OtherCOMMUNITY CHOICE
MI110B610050OtherBCBS OF MICHIGAN
MIH22298Medicare UPIN
MI110B610050OtherBCBS OF MICHIGAN
MI383567566100OtherCOMMUNITY CHOICE