Provider Demographics
NPI:1457567539
Name:KIRKOR VAHE KARACHORLU MD LTD
Entity type:Organization
Organization Name:KIRKOR VAHE KARACHORLU MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRKOR
Authorized Official - Middle Name:V
Authorized Official - Last Name:KARACHORLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-962-4428
Mailing Address - Street 1:PO BOX 2910
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 W 64TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3114
Practice Address - Country:US
Practice Address - Phone:773-962-4428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044607207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2360243Medicaid
IN200334830Medicaid
IL220001770OtherRR MEDICARE
IL036044607Medicaid
IL01638869OtherANTHEM BCBS OF IL
WI80997400Medicaid
IL031600704OtherBCBS IL
MN198437300Medicaid
IL208809Medicare PIN
C45907Medicare UPIN