Individual
JON BLAKE CHADWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6301 UNIVERSITY COMMONS, SUITE 360, SOUTH BEND, IN 46635-1571
(574) 232-4800
(574) 280-4810
Mailing address
6301 UNIVERSITY COMMONS, SUITE 360, SOUTH BEND, IN 46635-1571
(574) 232-4800
(574) 280-4810
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
01061815A
IN
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
35 085143
OH
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
39547
KY
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
43615
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000485851
ANTHEM PIN
IN
01
—
01061815A
INDIANA LICENSE
IN
05
—
200523340A
—
IN
Enumeration date
05/09/2006
Last updated
03/07/2023
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