Individual
CHANKEE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16570 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1106
(586) 263-7660
(586) 286-4727
Mailing address
16570 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1106
(586) 263-7660
(586) 286-4727
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
037049
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4590264
—
MI
Enumeration date
06/28/2006
Last updated
02/28/2012
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