Healthcare Provider Details

I. General information

NPI: 1811316813
Provider Name (Legal Business Name): PRITHA CHITAGI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 GULL RD
KALAMAZOO MI
49048-1640
US

IV. Provider business mailing address

1521 GULL ROAD
KALAMAZOO MI
49048
US

V. Phone/Fax

Practice location:
  • Phone: 269-226-5165
  • Fax:
Mailing address:
  • Phone: 269-226-7420
  • Fax: 269-226-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301105513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: