Provider Demographics
NPI:1366434318
Name:NAGAPPALA, BEENA (MD)
Entity type:Individual
Prefix:
First Name:BEENA
Middle Name:
Last Name:NAGAPPALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42645 GARFIELD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5022
Mailing Address - Country:US
Mailing Address - Phone:586-286-0050
Mailing Address - Fax:586-286-0880
Practice Address - Street 1:42645 GARFIELD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5022
Practice Address - Country:US
Practice Address - Phone:586-286-0050
Practice Address - Fax:586-286-0880
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4612530Medicaid
N40170074Medicare PIN
MIH75287Medicare UPIN