Provider Demographics
NPI:1861074460
Name:CHINNAPPAN, JUSTINE AUXILIA IRENE
Entity type:Individual
Prefix:
First Name:JUSTINE AUXILIA
Middle Name:IRENE
Last Name:CHINNAPPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22301 FOSTER WINTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3707
Mailing Address - Country:US
Mailing Address - Phone:248-849-3541
Mailing Address - Fax:248-849-2899
Practice Address - Street 1:22301 FOSTER WINTER DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3707
Practice Address - Country:US
Practice Address - Phone:248-849-3541
Practice Address - Fax:248-849-2899
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.151234207R00000X
MI4301514206207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine