1932126968 NPI number — JAMES F CHMIEL MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932126968 NPI number — JAMES F CHMIEL MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHMIEL

Provider First Name:

JAMES

Provider Middle Name:

F

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1932126968

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/11/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 1026

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:

46206-1026

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

317-777-6435

Provider Business Mailing Address Fax Number:

317-777-6644

Provider First Line Business Practice Location Address:

705 RILEY HOSPITAL DR # 4270

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

INDIANAPOLIS

Provider Business Practice Location Address State Name:

IN

Provider Business Practice Location Address Postal Code:

46202-5109

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

317-948-7208

Provider Business Practice Location Address Fax Number:

317-944-7247

Provider Enumeration Date:

07/16/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2080P0214X , with the licence number:  35-068239 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0214X , with the licence number: 01081273A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 728311 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0017495140001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 2080859 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 2080859 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 2111349 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000027777 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 363421 . This is a "WELLCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000221347 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 1932126968 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000525888 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".