Provider Demographics
NPI:1467786046
Name:CHUGHTAI, HAROON LATIF (MD)
Entity Type:Individual
Prefix:
First Name:HAROON
Middle Name:LATIF
Last Name:CHUGHTAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 E HUEBBE PKWY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-363-7395
Practice Address - Street 1:1969 W. HART ROAD
Practice Address - Street 2:BELOIT MEMORIAL HOSPITAL
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2298
Practice Address - Country:US
Practice Address - Phone:608-364-5011
Practice Address - Fax:608-363-7377
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094340207R00000X
WI60844-20207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467786046Medicaid