Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 4301063374 | MI |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4301063374 | MI |
NPI | 1568423986 |
---|---|
Provider Name | Joe S Chomchai |
First Address | Mount Pleasant, MI 48858-2042 |
Second Address | Mount Pleasant, MI 48858-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000370081 | BCBSM (01) | MI |
040016591 | PALMETTO GBA (01) | MI |
4337981 | (05) | MI |
4645845 | (05) | MI |
H04421 | (02) | MI |