Provider Demographics
NPI:1700823127
Name:CHAKU, VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:CHAKU
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 1:3400 SHATTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3157
Mailing Address - Country:US
Mailing Address - Phone:989-791-2512
Mailing Address - Fax:989-791-2534
Practice Address - Street 1:3400 SHATTUCK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3157
Practice Address - Country:US
Practice Address - Phone:989-791-2512
Practice Address - Fax:989-791-2534
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVC046248207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2725830Medicaid
MI2725830Medicaid
MI0731669Medicare ID - Type Unspecified