Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 01040295 | IN |
N | 207YS0123X | Facial Plastic Surgeon | 01040295 | IN |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 01040295 | IN |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 01040295 | IN |
NPI | 1679605539 |
---|---|
Provider Name | William G Chernoff |
First Address | Indianapolis, IN 46260-5381 |
Second Address | Indianapolis, IN 46260-5381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 30/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000091358 | ANTHEM (01) | IN |
A051787 | LICENSE (01) | CA |
F63698 | (02) | IN |