Provider Demographics
NPI:1801878111
Name:CHOWDHURY, PERTHA S (MD)
Entity type:Individual
Prefix:DR
First Name:PERTHA
Middle Name:S
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:STE 232
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-5100
Mailing Address - Fax:248-551-2304
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:STE 232
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-5100
Practice Address - Fax:248-551-2304
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070348207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I18128Medicare UPIN
0F38173Medicare ID - Type Unspecified