Provider Demographics
NPI:1265412449
Name:CHARARA, KASSEM M (MD)
Entity type:Individual
Prefix:DR
First Name:KASSEM
Middle Name:M
Last Name:CHARARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KASSEM
Other - Middle Name:M
Other - Last Name:SHARARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6211 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2405
Mailing Address - Country:US
Mailing Address - Phone:313-581-1222
Mailing Address - Fax:313-581-6657
Practice Address - Street 1:6211 CHASE RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2107
Practice Address - Country:US
Practice Address - Phone:313-581-1222
Practice Address - Fax:313-581-6657
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKC060523208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM18430001OtherMEDICARE ID
MI1040957460Medicaid
MI383533086OtherCOMERCIAL
MIM18430001OtherMEDICARE ID
MI1040957460Medicaid