Healthcare Provider Details

I. General information

NPI: 1396051462
Provider Name (Legal Business Name): ADRIAN CHAPA-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ADRIAN CHAPA M.D.

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 CARNEGIE BLVD STE 500
FORT WAYNE IN
46804-5788
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-5400
  • Fax: 260-425-6745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.131889
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number300996
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number036.131889
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number01086547A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: