Healthcare Provider Details

I. General information

NPI: 1356905632
Provider Name (Legal Business Name): HAMED CHEHAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 07/03/2024
Certification Date: 06/26/2024
Deactivation Date: 12/04/2019
Reactivation Date: 12/16/2019

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

1120 W MICHIGAN ST GATCH HALL. SUITE 578
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 917-724-1475
  • Fax:
Mailing address:
  • Phone: 317-278-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: