Individual
ROSE CHISENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-8776
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01089991A
IN
207R00000X
Internal Medicine Physician
5101026908
MI
390200000X
Student in an Organized Health Care Education/Training Program
125.074531
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010893
MEDICARE PTAN
IN
05
—
300076128
—
IN
Enumeration date
06/26/2019
Last updated
08/17/2023
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