Provider Demographics
NPI:1548765522
Name:ROPERT, CHELAN
Entity Type:Individual
Prefix:
First Name:CHELAN
Middle Name:
Last Name:ROPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELAN
Other - Middle Name:
Other - Last Name:GUISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5492 N RONALD REAGAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-5618
Mailing Address - Country:US
Mailing Address - Phone:317-852-3851
Mailing Address - Fax:
Practice Address - Street 1:5492 N RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-5618
Practice Address - Country:US
Practice Address - Phone:317-852-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007310A207Q00000X
IN11021046A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11021046AOtherPOSTGRADUATE TRAINING PERMIT - INDIANA PROFESSIONAL LICENSING AGENCY