Provider Demographics
NPI:1730522830
Name:CHASAN, JOEL ERIC (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ERIC
Last Name:CHASAN
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 1:8679 CONNECTICUT STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6383
Mailing Address - Country:US
Mailing Address - Phone:219-769-9022
Mailing Address - Fax:219-649-2995
Practice Address - Street 1:8679 CONNECTICUT STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6383
Practice Address - Country:US
Practice Address - Phone:219-769-9022
Practice Address - Fax:219-649-2995
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058598207W00000X
IL036150656207W00000X
390200000X
IN01082893A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300031137Medicaid
IL036150656Medicaid