Provider Demographics
NPI:1508879826
Name:CHUBB, WILLIAM (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CHUBB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1011
Mailing Address - Country:US
Mailing Address - Phone:608-829-2535
Mailing Address - Fax:608-829-1319
Practice Address - Street 1:6661 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1011
Practice Address - Country:US
Practice Address - Phone:608-829-2535
Practice Address - Fax:608-829-1319
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI676213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43219900Medicaid
WI85214Medicare ID - Type UnspecifiedGROUP NUMBER
U50470Medicare UPIN
WI85097Medicare ID - Type UnspecifiedGROUP NUMBER