Healthcare Provider Details

I. General information

NPI: 1407122740
Provider Name (Legal Business Name): SUMIT RISHI CHAWLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HOSPITAL LN STE 303
DANVILLE IN
46122-1998
US

IV. Provider business mailing address

112 HOSPITAL LN STE 303
DANVILLE IN
46122-1998
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4000
  • Fax: 317-718-4005
Mailing address:
  • Phone: 317-718-4000
  • Fax: 317-718-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD40553
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number75429
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01081272A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: