1457567539 NPI number — KIRKOR VAHE KARACHORLU MD LTD

Table of content: (NPI 1457567539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457567539 NPI number — KIRKOR VAHE KARACHORLU MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRKOR VAHE KARACHORLU MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457567539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46206-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 W 64TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60621-3114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-962-4428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KARACHORLU
Authorized Official First Name:
KIRKOR
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-962-4428

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  036044607 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2360243 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200334830 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220001770 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036044607 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01638869 . This is a "ANTHEM BCBS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 80997400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 031600704 . This is a "BCBS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 198437300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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