Provider Demographics
NPI:1356476287
Name:CHUBE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CHUBE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHUBE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:219-882-0980
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:1701 BROADWAY
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407
Mailing Address - Country:US
Mailing Address - Phone:219-882-0980
Mailing Address - Fax:219-882-5065
Practice Address - Street 1:1701 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407
Practice Address - Country:US
Practice Address - Phone:219-882-0980
Practice Address - Fax:219-882-5065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01017944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100161170Medicaid
TN627310AMedicare ID - Type Unspecified
TN100161170Medicaid