Basic Information
| Provider Information | |||||||||
| NPI: | 1982160842 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHAKER DAHAN LLC | ||||||||
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| 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: | 02/15/2019 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | DAHAN | ||||||||
| AuthorizedOfficialFirstName: | CHAKER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3212316795 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.