Healthcare Provider Details

I. General information

NPI: 1689670721
Provider Name (Legal Business Name): CHARLES RANDALL CHUBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RANDALL CHUBE M.D.

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9339 CALUMET AVE STE A
MUNSTER IN
46321-2879
US

IV. Provider business mailing address

8135 CALUMET AVE
MUNSTER IN
46321-1701
US

V. Phone/Fax

Practice location:
  • Phone: 219-513-8275
  • Fax: 219-595-5436
Mailing address:
  • Phone: 219-513-8275
  • Fax: 219-595-5436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01045841A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: