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General NPI Number Information
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NPI Number | 1952623787
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Entity Type | Organization
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Legal Business Name | CHAIRAT CHOMCHAI M.D P.C
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Dates
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Enumeration Date | 02/21/2010
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Last Update Date | 02/21/2010
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Provider Practice Location Address
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Address Line | 28111 HOOVER RD SUITE 6A
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City | WARREN
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State | MI
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Zip | 48093-4153
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Country | US
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Telephone | 586-751-4230
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Fax | 586-751-9260
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Provider Business Mailing Address
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Address Line | 28111 HOOVER RD SUITE 6A
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City | WARREN
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State | MI
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Zip | 48093-4153
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Country | US
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Telephone | 586-751-4230
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Fax | 586-751-9260
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAIRAT CHOMCHAI
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Credential | M.D.
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Telephone | 586-751-4230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 4301032652
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License Number State | MI
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