Provider Demographics
NPI:1134195480
Name:CHWIKANI, RAGHDA (MD)
Entity type:Individual
Prefix:DR
First Name:RAGHDA
Middle Name:
Last Name:CHWIKANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1659
Mailing Address - Country:US
Mailing Address - Phone:313-581-2064
Mailing Address - Fax:313-581-3590
Practice Address - Street 1:10326 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1659
Practice Address - Country:US
Practice Address - Phone:313-581-2064
Practice Address - Fax:313-581-3590
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056496208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3180397Medicaid
MI3508255982OtherBCBSM
MI383258747OtherBCBSM
MI3180397Medicaid
MD0P10070001Medicare PIN