Provider Demographics
NPI:1477578631
Name:CHUMAN, CHARLES MYLAN SR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MYLAN
Last Name:CHUMAN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-0009
Mailing Address - Country:US
Mailing Address - Phone:219-757-6410
Mailing Address - Fax:219-757-6166
Practice Address - Street 1:297 W FRANCISCAN LANE
Practice Address - Street 2:SUITE 207
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4859
Practice Address - Country:US
Practice Address - Phone:219-757-6410
Practice Address - Fax:219-757-6166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01035829207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0004048160OtherAETNA
IN000000080236OtherANTHEM
IN0091107960OtherILLINOIS BLUE CROSS
IN000000080236OtherANTHEM
IN0091107960OtherILLINOIS BLUE CROSS