Individual
TIMOTHY R CHAMBERLAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
344 N. MAIN ST., COLUMBIA CITY, IN 46725
(260) 248-2575
(260) 248-2726
Mailing address
1234 E. DUPONT RD., SUITE 3, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
1033472
IN
208600000X
Surgery Physician
Primary
01033472A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000603874
ANTHEM
IN
01
—
020004909
RAILROAD MEDICARE
IN
05
—
100263100
—
IN
01
—
85760
ANTHEM BCBS
IN
01
—
P00732002
RAILROAD MEDICARE
IN
Enumeration date
05/05/2006
Last updated
03/19/2013
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