Basic Information
| Provider Information | |||||||||
| NPI: | 1952305419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | KELLY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652985706 | ||||||||
| FaxNumber: | 7652985279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652985280 | ||||||||
| FaxNumber: | 7652985279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2005 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 01023840A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200843690 | 05 | IN | MEDICAID | 0000004977712 | 01 | IN | ANTHEM | OTHER | P00391678 | 01 | IN | RR MEDICARE | OTHER |