Provider Demographics
NPI:1255376364
Name:NUNAMAKER, CHAD MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
Last Name:NUNAMAKER
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:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:645 W 5TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3172
Practice Address - Country:US
Practice Address - Phone:812-634-2778
Practice Address - Fax:812-634-2909
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000829213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000205809OtherANTHEM
IN200978290Medicaid
IN151450BMedicare PIN