Healthcare Provider Details

I. General information

NPI: 1811070022
Provider Name (Legal Business Name): HARAGA CHENGAPPA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 MAIN ST BELLEVILLE HEALTH CARE PC
BELLEVILLE MI
48111
US

IV. Provider business mailing address

265 MAIN ST BELLEVILLE HEALTH CARE PC
BELLEVILLE MI
48111
US

V. Phone/Fax

Practice location:
  • Phone: 734-697-9300
  • Fax: 734-697-0374
Mailing address:
  • Phone: 734-697-9300
  • Fax: 734-697-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301062555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: