Individual
ANITA IRENE CHAROCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9606
(616) 252-7200
(616) 252-6239
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101010442
MI
207R00000X
Internal Medicine Physician
OS13558
FL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
5101010442
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
OS13558
FL
207RN0300X
Nephrology Physician
5101010442
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4846754
—
MI
01
—
70-0-F32947-0
BCBS CPIN #
MI
01
—
AC010442
BCBSM
MI
Enumeration date
06/02/2005
Last updated
09/15/2020
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