Provider Demographics
NPI:1811070022
Name:CHENGAPPA, HARAGA (MD)
Entity type:Individual
Prefix:
First Name:HARAGA
Middle Name:
Last Name:CHENGAPPA
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 1:265 MAIN ST
Mailing Address - Street 2:BELLEVILLE HEALTH CARE PC
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111
Mailing Address - Country:US
Mailing Address - Phone:734-697-9300
Mailing Address - Fax:734-697-0374
Practice Address - Street 1:265 MAIN ST
Practice Address - Street 2:BELLEVILLE HEALTH CARE PC
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111
Practice Address - Country:US
Practice Address - Phone:734-697-9300
Practice Address - Fax:734-697-0374
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF84195OtherHEALTH ALLIANCE PLAN
MI001066OtherMIDWEST HEALTH PLAN
MI383254111OtherTAX ID# COMMERCIAL INS
MI319935210Medicaid
MI700H210540OtherBCBS
MI122538OtherGREAT LAKES HEALTH PLAN
MI125085OtherCARE CHOICE
MIF84195OtherHEALTH ALLIANCE PLAN
MI319935210Medicaid