Provider Demographics
NPI:1831192640
Name:CHAE, WON B (MD)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:B
Last Name:CHAE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29829 TELEGRAPH RD
Mailing Address - Street 2:STE L103
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1376
Mailing Address - Country:US
Mailing Address - Phone:248-352-9525
Mailing Address - Fax:248-357-2959
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:STE L103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1376
Practice Address - Country:US
Practice Address - Phone:248-352-9525
Practice Address - Fax:248-357-2959
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWC0580392085R0202X, 2085B0100X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3349772Medicaid
MA132484OtherGREAT LAKES HEALTH PLAN
MI18674OtherHEALTH PLAN OF MICHIGAN
MI5101OtherCAPE HEALTH
MI52972OtherOMNICARE
MI1770819864OtherNPI
MICD9258OtherRAILROAD MEDICARE
MI4997089Medicaid
MI700F372090OtherBLUE CROSS BLUE SHIELD
MIRA630034OtherMCARE
MI3349772Medicaid
MI700F372090OtherBLUE CROSS BLUE SHIELD
MI5101OtherCAPE HEALTH
MI0M38520001Medicare ID - Type UnspecifiedMEDICARE
MI0P00030001Medicare PIN
MI0Z91063Medicare PIN