MEDICARE: BELLEVILLE HEALTH CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700H210540	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1912051004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLEVILLE HEALTH CARE PC

Provider Business Mailing Address
First Line	:	265 MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-3284
Country	:	US
Telephone Number	:	734-697-9300
Fax Number	:	734-697-0374

Provider Business Practice Location Address
First Line	:	265 MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-3284
Country	:	US
Telephone Number	:	734-697-9300
Fax Number	:	734-697-0374

Authorized Official
Title or Position	:	MEDICAL OFFICER
Name	:	DR. HARAGA CHENGAPPA
Credential	:	M.D.
Telephone Number	:	734-697-9300

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	01/31/2011

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Directions to “BELLEVILLE HEALTH CARE PC ” Practice Location

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