Healthcare Provider Details

I. General information

NPI: 1285126060
Provider Name (Legal Business Name): AMEYA ATUL CHUMBLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 RICE LAKE RD STE 109
DULUTH MN
55811-2885
US

IV. Provider business mailing address

4316 RICE LAKE RD STE 109
DULUTH MN
55811-2885
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-7363
  • Fax: 218-724-6199
Mailing address:
  • Phone: 218-724-7363
  • Fax: 218-724-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number79827
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number79827
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2018018678
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: