1477578631 NPI number — CHARLES MYLAN CHUMAN SR. M.D.

Table of content: CHARLES MYLAN CHUMAN SR. M.D. (NPI 1477578631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477578631 NPI number — CHARLES MYLAN CHUMAN SR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUMAN
Provider First Name:
CHARLES
Provider Middle Name:
MYLAN
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477578631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46304-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-757-6410
Provider Business Mailing Address Fax Number:
219-757-6166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
297 W FRANCISCAN LANE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
CROWN POINT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46307-4859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-757-6410
Provider Business Practice Location Address Fax Number:
219-757-6166
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  01035829 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0004048160 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000080236 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0091107960 . This is a "ILLINOIS BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com