Individual
EASA GHOREISHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
810 MICHAEL DR, SUITE I, CHESTERTON, IN 46304-2694
(219) 395-2142
(219) 929-4292
Mailing address
810 MICHAEL DR, SUITE I, CHESTERTON, IN 46304-2694
(219) 395-2142
(219) 929-4292
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01050773A
IN
207P00000X
Emergency Medicine Physician
Primary
C147933
CA
207QA0000X
Adolescent Medicine (Family Medicine) Physician
01050773A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000371646
ANTHEM
IN
05
—
200317290
—
IN
01
—
P00258168
RR MEDICARE
—
Enumeration date
09/19/2005
Last updated
04/01/2024
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