Healthcare Provider Details

I. General information

NPI: 1710581616
Provider Name (Legal Business Name): CHAHER ZOGHEIB FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 GREENFIELD RD STE 2E
DEARBORN MI
48126-4124
US

IV. Provider business mailing address

611 HIGHVIEW ST
DEARBORN MI
48128-1558
US

V. Phone/Fax

Practice location:
  • Phone: 313-740-1111
  • Fax:
Mailing address:
  • Phone: 313-213-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704327332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: