Provider Demographics
NPI:1194709584
Name:RANGANATHAN, CHAKRAPANI (MD)
Entity type:Individual
Prefix:
First Name:CHAKRAPANI
Middle Name:
Last Name:RANGANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7027
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-7027
Mailing Address - Country:US
Mailing Address - Phone:586-756-5500
Mailing Address - Fax:586-756-5511
Practice Address - Street 1:27427 SCHOENHERR RD
Practice Address - Street 2:STE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4729
Practice Address - Country:US
Practice Address - Phone:586-756-5500
Practice Address - Fax:586-756-5511
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014073442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI431929510Medicaid
MI431929510Medicaid
F78382Medicare UPIN