Provider Demographics
NPI:1245533371
Name:CHAKUDAKU, INC.
Entity type:Organization
Organization Name:CHAKUDAKU, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:248-787-6699
Mailing Address - Street 1:20755 GREENFIELD RD STE 502
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5408
Mailing Address - Country:US
Mailing Address - Phone:248-787-6699
Mailing Address - Fax:248-232-1517
Practice Address - Street 1:1401 ROSA PARKS BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1953
Practice Address - Country:US
Practice Address - Phone:313-309-9900
Practice Address - Fax:248-232-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment