Provider Demographics
NPI:1871605147
Name:CHUBINSKI, DENNIS JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOHN
Last Name:CHUBINSKI
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 1:1234 E. DUPONT RD.
Mailing Address - Street 2:3
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9700
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:8028 CARNEGIE BLVD.,
Practice Address - Street 2:400
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5788
Practice Address - Country:US
Practice Address - Phone:260-747-5572
Practice Address - Fax:260-747-8329
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000406A213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100359070AMedicaid
IN100359070BMedicaid
IN000000665116OtherANTHEM
OH0430199Medicaid
INP00895096OtherR.R. MEDICARE
INP00895096OtherR.R. MEDICARE
200420AMedicare ID - Type Unspecified
INM400021538Medicare PIN