Provider Demographics
NPI:1265010227
Name:MICHIGAN LUNG & SLEEP ASSOCIATION PC
Entity type:Organization
Organization Name:MICHIGAN LUNG & SLEEP ASSOCIATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULRAZAK
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALCHAKAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-909-7737
Mailing Address - Street 1:6300 N HAGGERTY RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4472
Mailing Address - Country:US
Mailing Address - Phone:248-909-7737
Mailing Address - Fax:
Practice Address - Street 1:26342 GIBRALTAR RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1522
Practice Address - Country:US
Practice Address - Phone:734-346-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265010227Medicaid