Provider Demographics
NPI:1225041973
Name:GACHAW, GABRA SADIK (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRA
Middle Name:SADIK
Last Name:GACHAW
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 1:6319 E US HYWY 36
Mailing Address - Street 2:BOX 50
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-272-2190
Mailing Address - Fax:
Practice Address - Street 1:6319 E US HIGHWAY 36 STE 50
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6210
Practice Address - Country:US
Practice Address - Phone:317-272-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034166A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
06014100OtherMAGELLAN
25087OtherMHN
000000091034OtherANTHEM BC/BS
075196OtherVALUE OPTIONS
IN100227780AMedicaid
4620202OtherAETNA
IN100227780Medicaid
11383779OtherCAQH
INE14005Medicare UPIN
IN100227780AMedicaid
25087OtherMHN
4620202OtherAETNA
075196OtherVALUE OPTIONS