Organization
CHEST CLINIC, PC
Active
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
Update your record
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