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Organization

CHEST CLINIC, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SIRAJ K AHMED M.D. (PHYSICIAN/PRESIDENT)
(219) 878-5864
Entity
Organization

Contact information

Practice address
10176 W 400 N, SUITE B, MICHIGAN CITY, IN 46360-9008
(219) 878-5864
(219) 878-0632
Mailing address
10176 W 400 N, SUITE B, MICHIGAN CITY, IN 46360-9008
(219) 878-5864
(219) 878-0632

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
50003970A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000104803
ANTHEM GROUP PROVIDER NUM
IN
05
100165460A
IN
05
200903550 A
IN
05
200903550B
IN
05
200903550C
IN
Enumeration date
10/18/2006
Last updated
04/28/2009
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