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: | |||||||||
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| 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: | 10/29/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 30723 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME74515 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4629 | 01 | FL | BCBS | OTHER |