Healthcare Provider Details

I. General information

NPI: 1871605147
Provider Name (Legal Business Name): DENNIS JOHN CHUBINSKI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 CARNEGIE BLVD., 400
FORT WAYNE IN
46804-5788
US

IV. Provider business mailing address

1234 E. DUPONT RD. 3
FORT WAYNE IN
46825-1545
US

V. Phone/Fax

Practice location:
  • Phone: 260-747-5572
  • Fax: 260-747-8329
Mailing address:
  • Phone: 260-373-9700
  • Fax: 260-373-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000406A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number07000406A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000406A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: