Provider Demographics
NPI:1174573281
Name:CHAPALA, VIJAYA K (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:K
Last Name:CHAPALA
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 1:3630 WILLOWCREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5075
Mailing Address - Country:US
Mailing Address - Phone:219-364-3700
Mailing Address - Fax:219-759-1804
Practice Address - Street 1:1101 GLENDALE BLVD STE 102A
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3767
Practice Address - Country:US
Practice Address - Phone:219-464-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45266207R00000X
NC9901142207R00000X
IN01076855A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201366760Medicaid