Provider Demographics
NPI:1457542920
Name:CHACRA, WADIH (MD)
Entity Type:Individual
Prefix:
First Name:WADIH
Middle Name:
Last Name:CHACRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W BETHUNE ST
Mailing Address - Street 2:APT 910
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2600
Mailing Address - Country:US
Mailing Address - Phone:313-529-5999
Mailing Address - Fax:
Practice Address - Street 1:1350 W BETHUNE ST
Practice Address - Street 2:APT 910
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2600
Practice Address - Country:US
Practice Address - Phone:313-529-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine