Healthcare Provider Details

I. General information

NPI: 1265954424
Provider Name (Legal Business Name): IN CHARGE MEDICAL PROFESSIONALS TN,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 WALNUT ST
CHATTANOOGA TN
37402
US

IV. Provider business mailing address

2741 W LAYTON AVE STE 106
MILWAUKEE WI
53221-2600
US

V. Phone/Fax

Practice location:
  • Phone: 414-312-5159
  • Fax: 888-724-0875
Mailing address:
  • Phone: 414-242-5468
  • Fax: 888-724-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JODI CZERNEJEWSKI
Title or Position: COO
Credential:
Phone: 262-510-6350