Healthcare Provider Details

I. General information

NPI: 1912051004
Provider Name (Legal Business Name): BELLEVILLE HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 MAIN ST
BELLEVILLE MI
48111-3284
US

IV. Provider business mailing address

265 MAIN ST
BELLEVILLE MI
48111-3284
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 TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HARAGA CHENGAPPA
Title or Position: MEDICAL OFFICER
Credential: M.D.
Phone: 734-697-9300