Provider Demographics
NPI:1669490769
Name:CHAVALI, SUBBARAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBBARAO
Middle Name:
Last Name:CHAVALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S. WENONA
Mailing Address - Street 2:SUITE G-28
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8831
Mailing Address - Country:US
Mailing Address - Phone:989-893-8116
Mailing Address - Fax:989-893-8151
Practice Address - Street 1:200 S WENONA ST
Practice Address - Street 2:SUITE G 28
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8820
Practice Address - Country:US
Practice Address - Phone:989-893-8116
Practice Address - Fax:989-893-8151
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0600901521OtherBLUE CROSS AND BLUE CARE
MI0982786OtherHEALTH PLUS
MIP00294280OtherTRAVELERS MEDICARE
MI4270309Medicaid
MI0982786OtherHEALTH PLUS
MI4270309Medicaid