Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301103228 | MI |
N | 207QA0505X | Family Doctor - Adult Medicine | 4301103228 | MI |
NPI | 1003158171 |
---|---|
Provider Name | Dr. Fadl A Chokr |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 05/01/2017 |