Provider Demographics
NPI:1720069016
Name:CHENGELIS, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:CHENGELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1380 COOLIDGE HWY
Mailing Address - Street 2:STE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7068
Mailing Address - Country:US
Mailing Address - Phone:248-291-6516
Mailing Address - Fax:248-291-6518
Practice Address - Street 1:1380 COOLIDGE HWY STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7068
Practice Address - Country:US
Practice Address - Phone:248-291-6516
Practice Address - Fax:248-291-6518
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058821208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI336438510Medicaid
MI0P24390002Medicare ID - Type Unspecified
MI336438510Medicaid
MI0P24390Medicare ID - Type Unspecified