Healthcare Provider Details

I. General information

NPI: 1255417515
Provider Name (Legal Business Name): MONIQUE CHIREAU WUBBENHORST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIQUE VERA CHIREAU MD

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 MARINERS DR
WARSAW IN
46582-7145
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 574-372-1282
  • Fax: 571-372-1275
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200000375
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01088465A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: