Basic Information
| Provider Information | |||||||||
| NPI: | 1366434318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGAPPALA | ||||||||
| FirstName: | BEENA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42645 GARFIELD RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480385022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862860050 | ||||||||
| FaxNumber: | 5862860880 | ||||||||
| Practice Location | |||||||||
| Address1: | 42645 GARFIELD RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480385022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862860050 | ||||||||
| FaxNumber: | 5862860880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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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 | 4301074847 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4612530 | 05 | MI | MEDICAID |