| Vijaya Challa, M.d.p.c. | |
|
7445 Allen Rd Suite 180 Allen Park MI 48101-1963 | |
| (810) 449-5456 | |
| Not Available |
| Full Name | Vijaya Challa, M.d.p.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 7445 Allen Rd, Allen Park, Michigan |
| Authorized Official Name and Position | Vijaya Challa (OWNER/PHYSICIA) |
| Authorized Official Contact | 8104495456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vijaya Challa, M.d.p.c. 7445 Allen Rd Suite 180 Allen Park MI 48101-1963 Ph: () - | Vijaya Challa, M.d.p.c. 7445 Allen Rd Suite 180 Allen Park MI 48101-1963 Ph: (810) 449-5456 |
| NPI Number | 1629332218 |
|---|---|
| Provider Enumeration Date | 06/27/2012 |
| Last Update Date | 06/27/2012 |
| Medicare PECOS PAC ID | 2264680396 |
|---|---|
| Medicare Enrollment ID | O20120914000715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629332218 | NPI | - | NPPES |
| 4865150 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | VC080035 (Michigan) | Primary |
| Provider Name | Vijaya N Challa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528016490 PECOS PAC ID: 1951312453 Enrollment ID: I20060516000059 |
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