Provider Demographics
NPI:1962472654
Name:CHAM, SATISH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SATISH
Middle Name:KUMAR
Last Name:CHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4530 ECHO RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1951
Mailing Address - Country:US
Mailing Address - Phone:313-587-5580
Mailing Address - Fax:
Practice Address - Street 1:22170 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6007
Practice Address - Country:US
Practice Address - Phone:248-475-6800
Practice Address - Fax:248-355-1402
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040701207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382507138OtherTAX ID
MI1594724Medicaid
MI2648200032OtherBCBS PROVIDER ID
MI1594724Medicaid
MI264820003Medicare ID - Type Unspecified