MEDICARE: CHATHAM CARE 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1073866687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATHAM CARE PC

Provider Business Mailing Address
First Line	:	907 N EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3425
Country	:	US
Telephone Number	:	317-644-3461
Fax Number	:	317-602-2654

Provider Business Practice Location Address
First Line	:	907 N EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3425
Country	:	US
Telephone Number	:	317-644-3461
Fax Number	:	317-602-2654

Authorized Official
Title or Position	:	OWNER
Name	:	DAVIED M BLACKWELL
Credential	:	MD
Telephone Number	:	317-644-3461

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	10/19/2012

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Directions to “CHATHAM CARE PC ” Practice Location

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