Jon Blake Chadwell
Otolaryngology/Facial Plastic Surgery
6301 University Commons Suite 360
South Bend
, Indiana 46635-1571
Jon Blake Chadwell
Otolaryngology/Facial Plastic Surgery
6301 University Commons Suite 360
South Bend
, Indiana 46635-1571
(574) 280-4810
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About
Features
Specialties
- Otolaryngology/Facial Plastic Surgery
Languages spoken
- English
Location
First Address
- Jon Blake Chadwell
- 6301 University Commons Suite 360
- South Bend, IN
- Zip : 46635-1571
- Fax : (574) 280-4810
- Phone : (574) 232-4800
Second Address
- Jon Blake Chadwell
- 6301 University Commons Suite 360
- South Bend, IN
- Zip : 46635-1571
- Fax : (574) 280-4810
- Phone : (574) 232-4800
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 01061815A | IN |
| N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 35 085143 | OH |
| N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 39547 | KY |
| N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 43615 | CO |
National Provider Identifier
| NPI | 1255380903 |
|---|---|
| Provider Name | Jon Blake Chadwell |
| First Address | South Bend, IN 46635-1571 |
| Second Address | South Bend, IN 46635-1571 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/05/2006 |
| Last Update Date | 24/01/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000485851 | ANTHEM PIN (01) | IN |
| 01061815A | INDIANA LICENSE (01) | IN |
| 200523340A | (05) | IN |
| BC9150878 | DEA (01) | IN |
| I34736 | (02) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.