Provider Demographics
NPI:1750364352
Name:CHAHBAZI, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:CHAHBAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:G3230 BEECHER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3604
Practice Address - Country:US
Practice Address - Phone:810-342-5656
Practice Address - Fax:810-342-5600
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010B56026OtherBLUE CROSS BLUE SHIELD
MI0802502601OtherBLUE CROSS BLUE SHIELD
MI204370OtherMCLAREN HEALTH PLAN
MI3269260Medicaid
MI010B56026OtherBLUE CHOICE
MI5208156OtherAETNA
MIG28616OtherHAP
MIG28616OtherHEALTH NET FEDERAL SERVIC
MI54C22105OtherHEALTH PLUS
MI8380794005OtherCIGNA
MIC5772OtherMCARE
MI010B56026OtherBLUE CARE NETWORK
MI204370OtherHEALTH ADVANTAGE NETWORK
MI010B56026OtherCOMMUNITY BLUE PPO
MI5208156OtherAETNA
MIG28616OtherHAP