Provider Demographics
NPI:1477086510
Name:USALA, RACHEL LEIGH (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEIGH
Last Name:USALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SISTER GRACE
Other - Middle Name:MIRIAM
Other - Last Name:USALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2025 W CHEESMAN RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-9760
Mailing Address - Country:US
Mailing Address - Phone:989-463-3451
Mailing Address - Fax:989-463-4956
Practice Address - Street 1:2025 W CHEESMAN RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9760
Practice Address - Country:US
Practice Address - Phone:989-463-3451
Practice Address - Fax:989-463-4956
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301511488207RE0101X
MO2022023566390200000X
OK35580207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200909970AMedicaid