Healthcare Provider Details

I. General information

NPI: 1073002986
Provider Name (Legal Business Name): OMAR CHEHAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date: 12/13/2018
Reactivation Date: 02/27/2019

III. Provider practice location address

4201 ST. ANTOINE ST SUITE 2E
DETROIT MI
48201
US

IV. Provider business mailing address

4201 ST. ANTOINE ST SUITE 2E
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4832
  • Fax:
Mailing address:
  • Phone: 313-745-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: