Organization Active NPI

Vijaya Challa, M.D.P.C.

  • Primary Care Clinic/Center
  • Dearborn, MI
National Provider Identifier
1629332218
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
VC080035 Issued in MI
Legal business name
VIJAYA CHALLA, M.D.P.C.
Practice address
24604 Michigan Ave Ste 100
Dearborn, MI 48124-1760
Phone
(313) 562-9020
Fax
(313) 562-8511
NPI assigned
Jun 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Venky R Challa
Title
Office Manager
Phone
(313) 562-9020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X VC080035 MI Primary

Addresses

Primary practice location

24604 Michigan Ave Ste 100
Dearborn, MI 48124-1760

Mailing address

24604 Michigan Ave Ste 100
Dearborn, MI 48124-1760
Phone (313) 562-9020

Other identifiers 1

IdentifierTypeStateIssuer
4865150MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120914000715 MI Part B Supplier - Clinic/Group Practice 2264680396 Receives reassigned benefits from 1 practitioner
Practice locations: Dearborn, MI; Wyandotte, MI; Wayne, MI; Taylor, MI

National Provider Directory

National Provider Directory

Locations

24604 Michigan Ave
Ste 100
Dearborn, MI 48124
Phone (313) 388-5540

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780876800000",
    "number": "1629332218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24604 MICHIGAN AVE STE 100",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241760",
            "telephone_number": "313-562-9020",
            "fax_number": "313-562-8511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24604 MICHIGAN AVE STE 100",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241760",
            "telephone_number": "313-562-9020",
            "fax_number": "313-562-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIJAYA CHALLA, M.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-27",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A",
        "authorized_official_last_name": "CHALLA",
        "authorized_official_first_name": "VENKY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "313-562-9020"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "VC080035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4865150",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.