Provider Demographics
NPI:1871191403
Name:CHAM CLINIC LLC
Entity Type:Organization
Organization Name:CHAM CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:INAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUHIDINE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:612-889-9344
Mailing Address - Street 1:7362 UNIVERSITY AVE NE STE 206
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3151
Mailing Address - Country:US
Mailing Address - Phone:612-889-9344
Mailing Address - Fax:
Practice Address - Street 1:7362 UNIVERSITY AVE NE STE 206
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3151
Practice Address - Country:US
Practice Address - Phone:612-889-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center