Individual
OMARI CHUBINIDZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 E CHESTNUT ST STE 303, LOUISVILLE, KY 40202-1831
(502) 629-5552
(502) 629-3132
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41262
KY
208M00000X
Hospitalist Physician
41262
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000522775
ANTHEM - NICC
—
01
—
090920
SIHO - NICC
—
01
—
098045
NCMA/SIHO
—
01
—
3704051000
PASSPORT ADVANTAGE- NORTON INPATIENT SPECIALISTS
KY
01
—
50023118
PASSPORT- NORTON INPATIENT SPECIALISTS
KY
01
—
P00434866
RAILROAD MEDICARE - KY
KY
Enumeration date
01/17/2007
Last updated
05/07/2019
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