Provider Demographics
NPI:1114307063
Name:CHERNOBY, GRANT FABIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:FABIAN
Last Name:CHERNOBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N SENATE AVE # B401
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3111
Mailing Address - Country:US
Mailing Address - Phone:317-994-4705
Mailing Address - Fax:
Practice Address - Street 1:701 N SENATE AVE # B401
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3111
Practice Address - Country:US
Practice Address - Phone:321-439-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101268806207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine