Provider Demographics
NPI:1487648242
Name:CHYBOWSKI, FRANK M (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:M
Last Name:CHYBOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1844
Mailing Address - Country:US
Mailing Address - Phone:920-730-5380
Mailing Address - Fax:
Practice Address - Street 1:1611 S MADISON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1844
Practice Address - Country:US
Practice Address - Phone:920-730-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33984208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31900300Medicaid
WI31900300Medicaid
WI014771018Medicare PIN
WI009045300Medicare PIN