Provider Demographics
NPI:1952623787
Name:CHAIRAT CHOMCHAI M.D P.C
Entity type:Organization
Organization Name:CHAIRAT CHOMCHAI M.D P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAIRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOMCHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-751-4230
Mailing Address - Street 1:28111 HOOVER RD
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4153
Mailing Address - Country:US
Mailing Address - Phone:586-751-4230
Mailing Address - Fax:586-751-9260
Practice Address - Street 1:28111 HOOVER RD
Practice Address - Street 2:SUITE 6A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4153
Practice Address - Country:US
Practice Address - Phone:586-751-4230
Practice Address - Fax:586-751-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032652208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0507655OtherBCBSM