Provider Demographics
NPI:1922561190
Name:SERVICE, CHAD AUSTIN
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:AUSTIN
Last Name:SERVICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:C
Other - Middle Name:AUSTIN
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-890-2000
Mailing Address - Fax:
Practice Address - Street 1:11380 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9840
Practice Address - Country:US
Practice Address - Phone:317-890-2000
Practice Address - Fax:317-859-7220
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01097474A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty