Provider Demographics
NPI:1841215332
Name:CHAK, AMITABH N (MD)
Entity Type:Individual
Prefix:
First Name:AMITABH
Middle Name:N
Last Name:CHAK
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-061996207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000539538OtherANTHEM
OH0848408Medicaid
741785OtherBUCKEYE
000000224253OtherUNISON
OH100006467OtherRAILROAD MEDICARE
363405OtherWELLCARE
OH0643889OtherAETNA
OHP00445621OtherRAILROAD MEDICARE
OH100006467OtherRAILROAD MEDICARE
OHCH0703381Medicare PIN
741785OtherBUCKEYE