Basic Information
| Provider Information | |||||||||
| NPI: | 1750364352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAHBAZI | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | G3230 BEECHER RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103425656 | ||||||||
| FaxNumber: | 8103425600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301068071 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010B56026 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 0802502601 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 204370 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 3269260 | 05 | MI | MEDICAID | 010B56026 | 01 | MI | BLUE CHOICE | OTHER | 5208156 | 01 | MI | AETNA | OTHER | G28616 | 01 | MI | HAP | OTHER | G28616 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 54C22105 | 01 | MI | HEALTH PLUS | OTHER | 8380794005 | 01 | MI | CIGNA | OTHER | C5772 | 01 | MI | MCARE | OTHER | 010B56026 | 01 | MI | BLUE CARE NETWORK | OTHER | 204370 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 010B56026 | 01 | MI | COMMUNITY BLUE PPO | OTHER |