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General NPI Number Information
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NPI Number | 1669490769
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Entity Type | Individual
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Provider Name | SUBBARAO CHAVALI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 200 S WENONA ST SUITE G 28
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City | BAY CITY
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State | MI
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Zip | 48706-8820
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Country | US
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Telephone | 989-893-8116
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Fax | 989-893-8151
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Provider Business Mailing Address
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Address Line | 200 S. WENONA SUITE G-28
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City | BAY CITY
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State | MI
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Zip | 48706-8831
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Country | US
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Telephone | 989-893-8116
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Fax | 989-893-8151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4301055651
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License Number State | MI
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