Basic Information
Provider Information
NPI: 1003803412
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAHAN
FirstName: CHAKER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: DAHAN
OtherFirstName: CHUCK
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 2
Mailing Information
Address1: 6833 VALHALLA WAY
Address2:  
City: WINDERMERE
State: FL
PostalCode: 347865627
CountryCode: US
TelephoneNumber: 3212316795
FaxNumber: 4072175856
Practice Location
Address1: 6833 VALHALLA WAY
Address2:  
City: WINDERMERE
State: FL
PostalCode: 347865627
CountryCode: US
TelephoneNumber: 3212316795
FaxNumber: 4072175856
Other Information
ProviderEnumerationDate: 09/30/2005
LastUpdateDate: 04/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME74515FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
462901FLBCBSOTHER


Home