Healthcare Provider Details

I. General information

NPI: 1982770285
Provider Name (Legal Business Name): DION DEBRO CHAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 NORTH MERIDIAN STREET SUITE 104
INDIANAPOLIS IN
46260-5349
US

IV. Provider business mailing address

9002 N MERIDIAN ST SUITE 104
INDIANAPOLIS IN
46260-5381
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-7706
  • Fax: 317-843-9604
Mailing address:
  • Phone: 317-844-7706
  • Fax: 317-843-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number01042615
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number01042615
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: