Provider Demographics
NPI:1780987156
Name:LOURIN CHAHIN MD PLLC
Entity type:Organization
Organization Name:LOURIN CHAHIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-376-4821
Mailing Address - Street 1:3879 TEAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1055
Mailing Address - Country:US
Mailing Address - Phone:248-376-4821
Mailing Address - Fax:586-254-3872
Practice Address - Street 1:1950 E WATTLES RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5099
Practice Address - Country:US
Practice Address - Phone:248-376-4821
Practice Address - Fax:586-254-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301079583OtherMICHIGAN STATE LICENSE