Provider Demographics
NPI:1679605539
Name:CHERNOFF, WILLIAM G (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:CHERNOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5381
Mailing Address - Country:US
Mailing Address - Phone:317-573-8899
Mailing Address - Fax:317-818-2008
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:317-573-8899
Practice Address - Fax:317-818-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040295207Y00000X, 207YS0123X, 207YX0007X, 207YX0905X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091358OtherANTHEM
CAA051787OtherLICENSE
INF63698Medicare UPIN
IN898290AMedicare ID - Type Unspecified