MEDICARE: CHEST CLINIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	50003970A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000104803	OTHER	IN	ANTHEM GROUP PROVIDER NUM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053492926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEST CLINIC, PC

Provider Business Mailing Address
First Line	:	10176 W 400 N
Second Line	:	SUITE B
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9008
Country	:	US
Telephone Number	:	219-878-5864
Fax Number	:	219-878-0632

Provider Business Practice Location Address
First Line	:	10176 W 400 N
Second Line	:	SUITE B
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9008
Country	:	US
Telephone Number	:	219-878-5864
Fax Number	:	219-878-0632

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	SIRAJ K AHMED
Credential	:	M.D.
Telephone Number	:	219-878-5864

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/28/2009

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Directions to “CHEST CLINIC, PC ” Practice Location

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