Provider Demographics
NPI:1467432682
Name:CHAKER, MHD HAITHAM (MD)
Entity type:Individual
Prefix:
First Name:MHD
Middle Name:HAITHAM
Last Name:CHAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:140 STONECREST RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8144
Mailing Address - Country:US
Mailing Address - Phone:502-633-1151
Mailing Address - Fax:502-633-5282
Practice Address - Street 1:140 STONECREST RD STE 203
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8144
Practice Address - Country:US
Practice Address - Phone:502-633-1151
Practice Address - Fax:502-633-5282
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35377207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000901376OtherBCBS
KY465301590OtherTRICARE
KY64070048Medicaid
H10133Medicare UPIN
KY64070048Medicaid
KY8147Medicare PIN
IN200454830AMedicaid