1326251620 NPI number — RADHIKA R CHINTALAPALLY MD

Table of content: RADHIKA R CHINTALAPALLY MD (NPI 1326251620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326251620 NPI number — RADHIKA R CHINTALAPALLY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHINTALAPALLY
Provider First Name:
RADHIKA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326251620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLETON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48117-9461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-654-2169
Provider Business Mailing Address Fax Number:
734-654-2535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLETON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48117-9461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-654-2169
Provider Business Practice Location Address Fax Number:
734-654-2535
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301086143 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 172268 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700E86031 . This is a "BCBS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02214 . This is a "PARAMOUNT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0805811182 . This is a "BCBS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50548 . This is a "HEALTH PLAN OF MICHIGAN" identifier . This identifiers is of the category "OTHER".




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