Basic Information
Provider Information | |||||||||
NPI: | 1962472654 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHAM | ||||||||
FirstName: | SATISH | ||||||||
MiddleName: | KUMAR | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4530 ECHO RD | ||||||||
Address2: |   | ||||||||
City: | BLOOMFIELD HILLS | ||||||||
State: | MI | ||||||||
PostalCode: | 483021951 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3135875580 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 22170 W 9 MILE RD | ||||||||
Address2: |   | ||||||||
City: | SOUTHFIELD | ||||||||
State: | MI | ||||||||
PostalCode: | 480336007 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2484756800 | ||||||||
FaxNumber: | 2483551402 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/25/2006 | ||||||||
LastUpdateDate: | 01/30/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301040701 | MI | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 2084P0800X | 4301040701 | MI | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | 382507138 | 01 | MI | TAX ID | OTHER | 1594724 | 05 | MI |   | MEDICAID | 2648200032 | 01 | MI | BCBS PROVIDER ID | OTHER |