Provider Demographics
NPI:1356395719
Name:CHOUCAIR, MICHELLE M (M D)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:CHOUCAIR
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-8043
Mailing Address - Country:US
Mailing Address - Phone:937-339-8426
Mailing Address - Fax:937-333-9990
Practice Address - Street 1:3006 N COUNTY ROAD 25A STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1372
Practice Address - Country:US
Practice Address - Phone:937-339-8426
Practice Address - Fax:937-339-9790
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.080357207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2293192Medicaid
OH2293192Medicaid
H54290Medicare UPIN