Provider Demographics
NPI:1982674784
Name:SONG, HI CHUL (MD)
Entity Type:Individual
Prefix:
First Name:HI
Middle Name:CHUL
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17000 HUBBARD DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4258
Mailing Address - Country:US
Mailing Address - Phone:313-240-7595
Mailing Address - Fax:313-240-7599
Practice Address - Street 1:17000 HUBBARD DR
Practice Address - Street 2:SUITE 800
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4258
Practice Address - Country:US
Practice Address - Phone:313-240-7595
Practice Address - Fax:313-240-7599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039922208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA76441Medicare UPIN