Provider Demographics
NPI:1821068537
Name:DEARBORN MEDICAL WALKIN CLINIC
Entity Type:Organization
Organization Name:DEARBORN MEDICAL WALKIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-563-7878
Mailing Address - Street 1:2220 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-2213
Mailing Address - Country:US
Mailing Address - Phone:313-563-4506
Mailing Address - Fax:313-563-8443
Practice Address - Street 1:2220 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-2213
Practice Address - Country:US
Practice Address - Phone:313-563-4506
Practice Address - Fax:313-563-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040701207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1594724Medicaid
MI2648200032OtherBCBS PROVIDER ID
MI$$$$$$$$$OtherDR. CHAM SSN
MI2648200032OtherBCBS PROVIDER ID