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General NPI Number Information
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NPI Number | 1174030605
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Entity Type | Organization
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Legal Business Name | CHUBE2 PRIMARY CARE LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 600 GRANT ST
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City | GARY
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State | IN
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Zip | 46402-6001
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Country | US
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Telephone | 219-201-8178
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Fax |
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Provider Business Mailing Address
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Address Line | 1024 KILLARNEY DR
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City | DYER
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State | IN
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Zip | 46311-1293
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CRYSTAL HUNT
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Credential |
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Telephone | 219-201-8178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01038347
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License Number State | KS
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