Basic Information
| Provider Information | |||||||||
| NPI: | 1467786046 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUGHTAI | ||||||||
| FirstName: | HAROON | ||||||||
| MiddleName: | LATIF | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1905 E HUEBBE PKWY | ||||||||
| Address2: | BELOIT HEALTH SYSTEM INC | ||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535111842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083642200 | ||||||||
| FaxNumber: | 6083637395 | ||||||||
| Practice Location | |||||||||
| Address1: | 1969 W. HART ROAD | ||||||||
| Address2: | BELOIT MEMORIAL HOSPITAL | ||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535112298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083645011 | ||||||||
| FaxNumber: | 6083637377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2009 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301094340 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 60844-20 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1467786046 | 05 | WI | MEDICAID |