Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 4301039874 | MI |
NPI | 1053387126 |
---|---|
Provider Name | Chintameni B Rao |
First Address | Marquette, MI 49855-2252 |
Second Address | Ishpeming, MI 49849-1367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356473 | (05) | MI |
3505221052 | BLUE CROSS BLUE SHIELD MI (01) | MI |
F06121 | (02) | MI |