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General NPI Number Information
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NPI Number | 1922488576
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Entity Type | Individual
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Provider Name | PETRA CHAMSEDDINE MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 5500 AUTO CLUB DR
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City | DEARBORN
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State | MI
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Zip | 48126-2779
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Country | US
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Telephone | 313-425-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-874-4806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | BP10052639
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 52218
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 4301504840
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301504840
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License Number State | MI
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