Provider Demographics
NPI:1619938073
Name:DAVIS, CHAD J (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8402 HARCOURT RD
Mailing Address - Street 2:STE 815
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2074
Mailing Address - Country:US
Mailing Address - Phone:317-872-1158
Mailing Address - Fax:317-872-1186
Practice Address - Street 1:8402 HARCOURT RD
Practice Address - Street 2:STE 815
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2074
Practice Address - Country:US
Practice Address - Phone:317-872-1158
Practice Address - Fax:317-872-1186
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN1033746A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN677800BOtherMEDICARE
IN000000084283OtherBLUE CROSS
330001346OtherRAILROAD MEDICARE
IN100131690Medicaid
IN351468850007OtherCIGNA
IN4362266OtherAETNA
IN4362266OtherAETNA