Provider Demographics
NPI:1487664421
Name:HOPRASART, POCHANA (MD, PC)
Entity type:Individual
Prefix:DR
First Name:POCHANA
Middle Name:
Last Name:HOPRASART
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:STE D
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:2070 BIDDLE AVE STE 2
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192
Practice Address - Country:US
Practice Address - Phone:734-284-7482
Practice Address - Fax:734-282-2002
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPH031675207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24657OtherBLUE CROSS
MI101173642Medicaid
MI1457586646OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H24657OtherBLUE CROSS
MI101173642Medicaid
MIM007073OtherTRICARE
MIA76443Medicare UPIN
MI0827623Medicare PIN
MI000000006527OtherCAPE HEALTH PLAN
MI160006624OtherRAILROAD MEDICARE
MI4277185OtherAETNA