Provider Demographics
NPI:1326251620
Name:CHINTALAPALLY, RADHIKA R (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:R
Last Name:CHINTALAPALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:130 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117-9461
Mailing Address - Country:US
Mailing Address - Phone:734-654-2169
Mailing Address - Fax:734-654-2535
Practice Address - Street 1:130 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CARLETON
Practice Address - State:MI
Practice Address - Zip Code:48117-9461
Practice Address - Country:US
Practice Address - Phone:734-654-2169
Practice Address - Fax:734-654-2535
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
172268OtherGREAT LAKES HEALTH PLAN
700E86031OtherBCBS OF MICHIGAN
02214OtherPARAMOUNT
0805811182OtherBCBS OF MICHIGAN
50548OtherHEALTH PLAN OF MICHIGAN
50548OtherHEALTH PLAN OF MICHIGAN
172268OtherGREAT LAKES HEALTH PLAN
700E86031OtherBCBS OF MICHIGAN
0805811182OtherBCBS OF MICHIGAN