Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901001839 | MI |
Y | 222Z00000X | Podiatrist | 5901001839 | MI |
NPI | 1003874520 |
---|---|
Provider Name | Steven F Challa |
First Address | Walker, MI 49534-8447 |
Second Address | Hastings, MI 49058-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 05/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3516431 | (05) | MI |
U66672 | (02) | MI |