Healthcare Provider Details

I. General information

NPI: 1497046452
Provider Name (Legal Business Name): CHAD EDWARD TEWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 N MERIDIAN ST SUITE 200
CARMEL IN
46032-1624
US

IV. Provider business mailing address

11455 N MERIDIAN ST SUITE 200
CARMEL IN
46032-1624
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8180
  • Fax:
Mailing address:
  • Phone: 317-582-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01076697A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: