Provider Demographics
NPI:1780022947
Name:CHEHAB, HIBA (MD)
Entity Type:Individual
Prefix:
First Name:HIBA
Middle Name:
Last Name:CHEHAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4744
Mailing Address - Country:US
Mailing Address - Phone:317-957-2000
Mailing Address - Fax:317-957-2050
Practice Address - Street 1:1633 N CAPITOL AVE STE 236
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1262
Practice Address - Country:US
Practice Address - Phone:317-957-2233
Practice Address - Fax:317-957-2233
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01077404A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300022300Medicaid