Organization
C.B. RAO, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHINTAMENI B RAO M.D. (OWNER)
(906) 488-5583
Entity
Organization
Contact information
Practice address
901 LAKE SHORE DR, ISHPEMING, MI 49849-1367
(906) 485-5583
Mailing address
2837 US HIGHWAY 41 W, MARQUETTE, MI 49855-2252
(906) 225-3964
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301039874
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101356473
—
MI
01
—
3505221052
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
02/13/2007
Last updated
11/11/2008
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