Healthcare Provider Details

I. General information

NPI: 1215908678
Provider Name (Legal Business Name): CHALAPATHIRAO V GUDIPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAO VC GUDIPATI MD

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S WASHINGTON AVE
SAGINAW MI
48601-2556
US

IV. Provider business mailing address

1015 S WASHINGTON AVE
SAGINAW MI
48601-2556
US

V. Phone/Fax

Practice location:
  • Phone: 989-754-3000
  • Fax: 989-755-1365
Mailing address:
  • Phone: 989-754-3000
  • Fax: 989-755-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301056478
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: