Provider Demographics
NPI:1003908054
Name:RAO, CHALICHAMA AN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHALICHAMA
Middle Name:AN
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHALICHAMA
Other - Middle Name:ANJANEYESWARA
Other - Last Name:NARASIMHARAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2100 HEMMETER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3944
Mailing Address - Country:US
Mailing Address - Phone:989-799-2100
Mailing Address - Fax:989-799-2637
Practice Address - Street 1:2100 HEMMETER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3944
Practice Address - Country:US
Practice Address - Phone:989-799-2100
Practice Address - Fax:989-799-2637
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010445292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1586375Medicaid
MI4301044529OtherSTATE MEDICAL LICENCE NUM
MI4301044529OtherSTATE MEDICAL LICENCE NUM
MI1586375Medicaid
AR2074778OtherDEA NUMBER