MEDICARE: JOE S CHOMCHAI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	4301063374	MI
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	4301063374	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040016591	OTHER	MI	PALMETTO GBA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000370081	OTHER	MI	BCBSM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568423986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE S CHOMCHAI M.D.

Provider Business Mailing Address
First Line	:	4851 E PICKARD ST STE 2700
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-2042
Country	:	US
Telephone Number	:	989-772-6848
Fax Number	:	989-317-9263

Provider Business Practice Location Address
First Line	:	4851 E PICKARD ST STE 2700
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-2042
Country	:	US
Telephone Number	:	989-772-6848
Fax Number	:	989-317-9263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	04/17/2020

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Directions to “ JOE S CHOMCHAI M.D.” Practice Location

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