Provider Demographics
NPI:1184716318
Name:LOUIS CHIARA MD PC
Entity type:Organization
Organization Name:LOUIS CHIARA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHIARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-684-1282
Mailing Address - Street 1:PO BOX 930319
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-0319
Mailing Address - Country:US
Mailing Address - Phone:248-684-1282
Mailing Address - Fax:248-684-2485
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1975
Practice Address - Country:US
Practice Address - Phone:248-684-1282
Practice Address - Fax:248-684-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045542207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4749920Medicaid
MI4749939Medicaid
0P19920Medicare ID - Type Unspecified
MI4749939Medicaid