1659420743 NPI number — MR. PRATAP ARAVAPALLI MD

Table of content: MR. PRATAP ARAVAPALLI MD (NPI 1659420743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659420743 NPI number — MR. PRATAP ARAVAPALLI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARAVAPALLI
Provider First Name:
PRATAP
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659420743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1051 PROFESSIONAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-720-1730
Provider Business Mailing Address Fax Number:
810-720-1736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S BALLENGER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-720-1730
Provider Business Practice Location Address Fax Number:
810-720-1736
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  4301054639 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2633934 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0996930 . This is a "HEALTH PLUS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: M001301 . This is a "TRICARE REGION 2 AND 5" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050B560430 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: AN250004 . This is a "MCARE INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA054639 . This is a "STATE LICENSE NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 252505 . This is a "MCLAREN HEALTH ADVANTAG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 252505 . This is a "MCLAREN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050B560430 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103621 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1172870001 . This is a "THE WELLNESS PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 567562 . This is a "SELECT C ARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0B56043013 . This is a "PERSONAL IDENTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30946 . This is a "COMMUNITY CHOICE OF MI M" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4647093 . This is a "AETNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: EM033063 . This is a "HEALTH ALLIANCE PLAN" identifier . This identifiers is of the category "OTHER".




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