Individual
IMAN S ABOU-CHAKRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 E MICHIGAN AVE, STE 300, JACKSON, MI 49201-1852
(517) 841-1431
(517) 841-1432
Mailing address
PO BOX 67000, DEPARTMENT 272801, DETROIT, MI 48267-2728
(517) 841-1431
(517) 841-1432
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301082675
MI
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
35083590
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000363133
ANTHEM INS
OH
01
—
11195950
CAQH
OH
05
—
2478591
—
OH
01
—
270046615-001
MEDICAL MUTUAL OF OHIO
OH
01
—
7138550
AETNA INS
OH
01
—
P00191177
RAILROAD MEDICARE
OH
Enumeration date
02/02/2006
Last updated
08/07/2012
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