Individual
BAHJAT SAMI CHABENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 N RITTER AVE, SUITE 120, INDIANAPOLIS, IN 46219-3052
(317) 355-1000
(317) 355-5440
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01024613A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000764829
ANTHEM
IN
05
—
100058480A
—
IN
01
—
P01211599
RR MEDICARE PTAN
IN
Enumeration date
11/20/2006
Last updated
11/30/2016
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