Individual
CONAN VON CHITTICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1520 N SENATE AVE, INDIANAPOLIS, IN 46202-2213
(317) 962-5423
(317) 962-6722
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01075578A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01075578A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001029711
ANTHEM PTAN
IN
01
—
000001029731
ANTHEM PTAN
IN
05
—
201091300
—
IN
01
—
264430444
MEDICARE PTAN
IN
Enumeration date
05/09/2012
Last updated
09/23/2024
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