Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 01040342A | IN |
NPI | 1306849468 |
---|---|
Provider Name | Dr. Frederick Theodore Chaykowski |
First Address | Fort Wayne, IN 46801-2526 |
Second Address | Fort Wayne, IN 46814-9159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 15/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000089405 | ANTHEM (01) | |
100340080A | (05) | IN |
200015790 | RAILROAD MEDICARE (01) | |
F66886 | (02) | IN |