Provider Demographics
NPI:1063538478
Name:CHAFTARI MEDICAL INC
Entity type:Organization
Organization Name:CHAFTARI MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SAMIR
Authorized Official - Last Name:CHAFTARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-592-5459
Mailing Address - Street 1:5119 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3317
Mailing Address - Country:US
Mailing Address - Phone:713-592-5459
Mailing Address - Fax:
Practice Address - Street 1:119 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3034
Practice Address - Country:US
Practice Address - Phone:318-215-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13244R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445380Medicaid