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Individual
MR. CHE SONG PARK
Active
Individual
MR. CHE SONG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
4301031253
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
280739862
BLUE CROSS BLUE SHIELD
MI
01
—
2898621
HEALTHPLUS
MI
Enumeration date
08/31/2006
Last updated
02/24/2011
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