Organization
PARK OB GYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANKEE PARK MD (PHYSICIAN PRESIDENT)
(586) 263-7660
Entity
Organization
Contact information
Practice address
16570 19 MILE RD, CLINTON TWP, MI 48038-1106
(586) 263-7660
(586) 263-4727
Mailing address
16570 19 MILE RD, CLINTON TWP, MI 48038-1106
(586) 263-7660
(586) 263-4727
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301037049
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518995869
—
MI
01
—
4301037049
LICENSE
MI
Enumeration date
08/24/2010
Last updated
02/17/2011
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