| Chestnut Health Of Indiana Pc | |
|
3518 S Lafountain St Kokomo IN 46902-3803 | |
| (765) 453-4667 | |
| Not Available |
| Full Name | Chestnut Health Of Indiana Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3518 S Lafountain St, Kokomo, Indiana |
| Authorized Official Name and Position | Omair Siraj (CEO) |
| Authorized Official Contact | 7039648199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chestnut Health Of Indiana Pc Po Box 1294 Bedford Park IL 60499-1294 Ph: (703) 964-8199 | Chestnut Health Of Indiana Pc 3518 S Lafountain St Kokomo IN 46902-3803 Ph: (765) 453-4667 |
| NPI Number | 1730884131 |
|---|---|
| Provider Enumeration Date | 04/04/2023 |
| Last Update Date | 07/11/2023 |
| Medicare PECOS PAC ID | 4183078215 |
|---|---|
| Medicare Enrollment ID | O20230923000203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730884131 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kuljit Kapur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831399518 PECOS PAC ID: 2860649985 Enrollment ID: I20210928000544 |
| Provider Name | Shaleena M Gates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700553906 PECOS PAC ID: 4082002589 Enrollment ID: I20211103001322 |
| Provider Name | Shannon D Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194310045 PECOS PAC ID: 8628486594 Enrollment ID: I20230925000322 |
| Provider Name | Lisa Diann Beyers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104538685 PECOS PAC ID: 1850527367 Enrollment ID: I20231120002131 |
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