Healthcare Provider Details

I. General information

NPI: 1982253159
Provider Name (Legal Business Name): SANTOSH CHIKINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27423 PARKVIEW BLVD APT 5210
WARREN MI
48092-3631
US

IV. Provider business mailing address

30250 JOHN R RD
MADISON HEIGHTS MI
48071-5205
US

V. Phone/Fax

Practice location:
  • Phone: 469-600-9659
  • Fax:
Mailing address:
  • Phone: 586-421-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005295
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: