Basic Information
| Provider Information | |||||||||
| NPI: | 1326251620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHINTALAPALLY | ||||||||
| FirstName: | RADHIKA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | CARLETON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481179461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346542169 | ||||||||
| FaxNumber: | 7346542535 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | CARLETON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481179461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346542169 | ||||||||
| FaxNumber: | 7346542535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301086143 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 172268 | 01 | GREAT LAKES HEALTH PLAN | OTHER | 700E86031 | 01 | BCBS OF MICHIGAN | OTHER | 02214 | 01 | PARAMOUNT | OTHER | 0805811182 | 01 | BCBS OF MICHIGAN | OTHER | 50548 | 01 | HEALTH PLAN OF MICHIGAN | OTHER |