Provider Demographics
NPI:1538546676
Name:CHITRAGARI, GAUTHAM (MD)
Entity type:Individual
Prefix:
First Name:GAUTHAM
Middle Name:
Last Name:CHITRAGARI
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 1:1901 STAR BATT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3767
Mailing Address - Country:US
Mailing Address - Phone:586-226-6122
Mailing Address - Fax:586-226-6123
Practice Address - Street 1:1901 STAR BATT DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3767
Practice Address - Country:US
Practice Address - Phone:586-226-6122
Practice Address - Fax:586-226-6123
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88113208600000X, 208C00000X
MI4301502519208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery