Provider Demographics
NPI:1215908678
Name:GUDIPATI, CHALAPATHIRAO V (MD)
Entity type:Individual
Prefix:DR
First Name:CHALAPATHIRAO
Middle Name:V
Last Name:GUDIPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAO
Other - Middle Name:VC
Other - Last Name:GUDIPATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1015 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2556
Mailing Address - Country:US
Mailing Address - Phone:989-754-3000
Mailing Address - Fax:989-755-1365
Practice Address - Street 1:1015 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2556
Practice Address - Country:US
Practice Address - Phone:989-754-3000
Practice Address - Fax:989-755-1365
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056478207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4526540Medicaid
MI4526540Medicaid
MIG36040022Medicare PIN