Provider Demographics
NPI:1063635035
Name:CHALUPA, DAVID E (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:CHALUPA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9159
Mailing Address - Country:US
Mailing Address - Phone:269-985-1000
Mailing Address - Fax:269-983-1627
Practice Address - Street 1:3950 HOLLYWOOD RD STE 110
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9151
Practice Address - Country:US
Practice Address - Phone:269-985-1000
Practice Address - Fax:269-983-3181
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M95350OtherGROUP MEDICARE PIN
0M95350OtherGROUP MEDICARE PIN