Provider Demographics
NPI:1598945099
Name:CHITRANJAN LALL MD PC
Entity Type:Organization
Organization Name:CHITRANJAN LALL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITRANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-745-7445
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-745-7445
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 507
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-745-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091382207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160000233OtherMEDICARE RAILROAD
MI1608281181OtherBLUE CARE NETWORK
MI1608281181OtherBCBS OF MICHIGAN
MI2107169Medicaid
MIA73417Medicare UPIN
MI2107169Medicaid