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General NPI Number Information
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NPI Number | 1952373078
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Entity Type | Individual
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Provider Name | IMAN S ABOU-CHAKRA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 1201 E MICHIGAN AVE STE 300
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City | JACKSON
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State | MI
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Zip | 49201-1852
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Country | US
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Telephone | 517-841-1431
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Fax | 517-841-1432
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Provider Business Mailing Address
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Address Line | PO BOX 67000 DEPARTMENT 272801
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City | DETROIT
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State | MI
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Zip | 48267-2728
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Country | US
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Telephone | 517-841-1431
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Fax | 517-841-1432
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 35083590
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301082675
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License Number State | MI
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