Provider Demographics
NPI:1942296835
Name:CHAKMAKIAN, STEPHEN DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAVID
Last Name:CHAKMAKIAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1600 W BROADWAY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1134
Mailing Address - Country:US
Mailing Address - Phone:480-968-6866
Mailing Address - Fax:480-350-2231
Practice Address - Street 1:1600 W BROADWAY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1134
Practice Address - Country:US
Practice Address - Phone:480-968-6866
Practice Address - Fax:480-350-2231
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH18090Medicare UPIN