Provider Demographics
NPI:1003874520
Name:CHALLA, STEVEN F (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:F
Last Name:CHALLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8447
Mailing Address - Country:US
Mailing Address - Phone:616-453-6329
Mailing Address - Fax:616-453-1725
Practice Address - Street 1:221 W APPLE ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1810
Practice Address - Country:US
Practice Address - Phone:269-945-2606
Practice Address - Fax:269-945-5122
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001839213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3516431Medicaid
MI4970960001Medicare NSC
MI3516431Medicaid
MI0N91440Medicare ID - Type UnspecifiedMEDICARE