Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 01025543 | IN |
NPI | 1508851338 |
---|---|
Provider Name | Ivan L Chermel |
First Address | Merrillville, IN 46410-6382 |
Second Address | Schererville, IN 46375-3402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 18/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000091542 | ANTHEM (01) | IN |
100192070 | (05) | IN |
D95520 | (02) | IN |