Provider Demographics
NPI:1669483632
Name:CHLEBECK, PAUL T (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:CHLEBECK
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 1:4405 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4187
Mailing Address - Country:US
Mailing Address - Phone:605-328-9000
Mailing Address - Fax:605-328-9001
Practice Address - Street 1:4405 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-4187
Practice Address - Country:US
Practice Address - Phone:605-328-9000
Practice Address - Fax:605-328-9001
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN880316100Medicaid
MN880316100Medicaid