Provider Demographics
NPI:1053387126
Name:RAO, CHINTAMENI B (MD)
Entity type:Individual
Prefix:
First Name:CHINTAMENI
Middle Name:B
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2837 US 41 W
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2252
Mailing Address - Country:US
Mailing Address - Phone:906-225-3964
Mailing Address - Fax:906-226-3875
Practice Address - Street 1:901 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-1367
Practice Address - Country:US
Practice Address - Phone:906-485-2668
Practice Address - Fax:906-485-5676
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010398742080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356473Medicaid
MI3505221052OtherBLUE CROSS BLUE SHIELD MI
MI3505221052OtherBLUE CROSS BLUE SHIELD MI