Provider Demographics
NPI:1689670721
Name:CHUBE, CHARLES RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RANDALL
Last Name:CHUBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:
Other - Last Name:CHUBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8135 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1701
Mailing Address - Country:US
Mailing Address - Phone:219-513-8275
Mailing Address - Fax:219-595-5436
Practice Address - Street 1:9339 CALUMET AVE STE A
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2879
Practice Address - Country:US
Practice Address - Phone:219-513-8275
Practice Address - Fax:219-595-5436
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045841A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200125320AMedicaid
IN01045841OtherLICENSE NUMBER
INFC6045531OtherDEA
IN200125320AMedicaid
IN200125320AMedicaid