Individual
ETHAN JOHN CHUPKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 PEELER ST, KALAMAZOO, MI 49008-2300
(269) 342-7833
Mailing address
900 PEELER ST, KALAMAZOO, MI 49008-2300
(269) 345-8618
(269) 345-1508
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704315820
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704315820
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704315820
MI LICENSE
MI
Enumeration date
10/27/2020
Last updated
11/19/2021
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