Individual
PETER J CHAILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11108 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1730
(260) 266-5700
(260) 266-5920
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01066356A
IN
207RI0011X
Interventional Cardiology Physician
Primary
01066356A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000641067
ANTHEM
IN
05
—
200935950
—
IN
01
—
2967160
OH MEDICAID
IN
01
—
P00786843
R.R. MEDICARE
IN
Enumeration date
11/02/2006
Last updated
06/03/2025
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