Provider Demographics
NPI:1114904091
Name:CHROBAK LLC
Entity Type:Organization
Organization Name:CHROBAK LLC
Other - Org Name:DOCTORS ON CALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CHROBAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:330-386-6339
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-5856
Mailing Address - Country:US
Mailing Address - Phone:330-386-6339
Mailing Address - Fax:330-386-1224
Practice Address - Street 1:332 W SIXTH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2812
Practice Address - Country:US
Practice Address - Phone:330-386-6339
Practice Address - Fax:330-386-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006156C207Q00000X, 2083X0100X
PA05008296L207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2080555Medicaid
G25092Medicare UPIN
OH2080555Medicaid