Provider Demographics
NPI:1982253159
Name:CHIKINE, SANTOSH
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:
Last Name:CHIKINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30250 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5205
Mailing Address - Country:US
Mailing Address - Phone:586-421-5174
Mailing Address - Fax:
Practice Address - Street 1:27423 PARKVIEW BLVD APT 5210
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3631
Practice Address - Country:US
Practice Address - Phone:469-600-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005295225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant