Healthcare Provider Details

I. General information

NPI: 1598345068
Provider Name (Legal Business Name): CARLY MICHAL CHAPMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/27/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 ROY WILSON WAY
NEW PALESTINE IN
46163-8032
US

IV. Provider business mailing address

4055 ROY WILSON WAY
NEW PALESTINE IN
46163-8032
US

V. Phone/Fax

Practice location:
  • Phone: 317-861-4171
  • Fax: 317-861-5325
Mailing address:
  • Phone: 317-861-4171
  • Fax: 317-861-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02007343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: