Provider Demographics
NPI:1700846367
Name:CHAE, SONG HAI NAM (MD)
Entity Type:Individual
Prefix:
First Name:SONG HAI
Middle Name:NAM
Last Name:CHAE
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:PO BOX 32615
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-0615
Mailing Address - Country:US
Mailing Address - Phone:313-593-7965
Mailing Address - Fax:313-593-7143
Practice Address - Street 1:10000 SOUTH TELEGRAPH ROAD
Practice Address - Street 2:HERITAGE HOSPITAL
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3330
Practice Address - Country:US
Practice Address - Phone:313-295-5000
Practice Address - Fax:313-295-5373
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI032355207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4417447Medicaid
MI4417447Medicaid