Provider Demographics
NPI:1508043738
Name:CHHAPAMOHAN, RAJABHAU MAHADEORAO (RPT)
Entity Type:Individual
Prefix:MR
First Name:RAJABHAU
Middle Name:MAHADEORAO
Last Name:CHHAPAMOHAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 US-23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2570
Mailing Address - Country:US
Mailing Address - Phone:989-657-3267
Mailing Address - Fax:
Practice Address - Street 1:2578 US-23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2570
Practice Address - Country:US
Practice Address - Phone:989-657-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4361280Medicaid