Healthcare Provider Details

I. General information

NPI: 1528016490
Provider Name (Legal Business Name): VIJAYA N CHALLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24604 MICHIGAN AVE STE 100
DEARBORN MI
48124-1760
US

IV. Provider business mailing address

24604 MICHIGAN AVE STE 100
DEARBORN MI
48124-1760
US

V. Phone/Fax

Practice location:
  • Phone: 313-562-9020
  • Fax: 313-562-8511
Mailing address:
  • Phone: 313-562-9020
  • Fax: 313-562-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: