Provider Demographics
NPI:1871598185
Name:CHAE, WILLIAM MOOWAN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MOOWAN
Last Name:CHAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36175 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3274
Mailing Address - Country:US
Mailing Address - Phone:586-741-3772
Mailing Address - Fax:586-741-4600
Practice Address - Street 1:36175 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3274
Practice Address - Country:US
Practice Address - Phone:586-741-3772
Practice Address - Fax:586-741-4600
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010313762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3558987Medicaid
0Q26008011OtherFED BLACK LUNG PROGRAM
300008866OtherPALMETTO GBA RR MEDICARE
MI0H26188OtherBCBS PROVIDER NUMBER
MI136661110OtherPROCARE
0H26188011OtherFED BLACK LUNG PROGRAM
MI110479OtherGREAT LAKES HEALTH
MI0Q26008OtherBCBS PROVIDER NUMBER
MI1006439OtherMCLAREN HEALTH
MI0Q26008OtherBCBS PROVIDER NUMBER
MI136661110OtherPROCARE
MIA78629Medicare UPIN
0Q26008011OtherFED BLACK LUNG PROGRAM
MI0Q26008OtherBCBS PROVIDER NUMBER