Healthcare Provider Details

I. General information

NPI: 1508866245
Provider Name (Legal Business Name): CHEST DISEASES ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8909 BROADWAY
MERRILLVILLE IN
46410-7039
US

IV. Provider business mailing address

8909 BROADWAY
MERRILLVILLE IN
46410-7039
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-0054
  • Fax: 219-769-1793
Mailing address:
  • Phone: 219-769-0054
  • Fax: 219-769-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number50002847A
License Number StateIN

VIII. Authorized Official

Name: HAKAM SAFADI
Title or Position: PRESIDENT
Credential: MD
Phone: 219-769-0054