Provider Demographics
NPI:1053492926
Name:CHEST CLINIC, PC
Entity Type:Organization
Organization Name:CHEST CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIRAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-878-5864
Mailing Address - Street 1:10176 W 400 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9008
Mailing Address - Country:US
Mailing Address - Phone:219-878-5864
Mailing Address - Fax:219-878-0632
Practice Address - Street 1:10176 W 400 N
Practice Address - Street 2:SUITE B
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9008
Practice Address - Country:US
Practice Address - Phone:219-878-5864
Practice Address - Fax:219-878-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003970A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200903550BMedicaid
IN100165460AMedicaid
IN200903550 AMedicaid
IN000000104803OtherANTHEM GROUP PROVIDER NUM
IN200903550CMedicaid
IN100165460AMedicaid
IN565490Medicare PIN