Provider Demographics
NPI:1952305419
Name:CHAMBERS, RICHARD KELLY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KELLY
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:765-298-5706
Mailing Address - Fax:765-298-5279
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3459
Practice Address - Country:US
Practice Address - Phone:765-298-5280
Practice Address - Fax:765-298-5279
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01023840A207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200843690Medicaid
IN0000004977712OtherANTHEM
INP00391678OtherRR MEDICARE
INP00391678OtherRR MEDICARE
INM400024624Medicare PIN