Provider Demographics
NPI:1912051004
Name:BELLEVILLE HEALTH CARE PC
Entity Type:Organization
Organization Name:BELLEVILLE HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARAGA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENGAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-697-9300
Mailing Address - Street 1:265 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3284
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:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3284
Practice Address - Country:US
Practice Address - Phone:734-697-9300
Practice Address - Fax:734-697-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H210540OtherBCBS
MI=========OtherEIN
MI0Q27600Medicare ID - Type UnspecifiedMEDICARE GROUP ID#