Healthcare Provider Details

I. General information

NPI: 1023712403
Provider Name (Legal Business Name): THEODOSIS J CHRONIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VILLAGE DR
PENDLETON IN
46064-8960
US

IV. Provider business mailing address

611 E DOUGLAS RD STE 407
MISHAWAKA IN
46545-1468
US

V. Phone/Fax

Practice location:
  • Phone: 765-778-0913
  • Fax:
Mailing address:
  • Phone: 574-335-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02008775A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: