Provider Demographics
NPI:1730172883
Name:CHAMBERLIN, JOHN (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-5242
Mailing Address - Fax:
Practice Address - Street 1:1500 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1301
Practice Address - Country:US
Practice Address - Phone:785-354-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21527208M00000X
KS04-21527208M00000X
MOR2E61207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2292233OtherAETNA
KS068002006OtherMEDICARE PTAN
KS100349200CMedicaid
330230OtherFIRST GUARD
12531038OtherBCBS
MO202253415Medicaid
KSI145789Medicare ID - Type Unspecified
MO202253415Medicaid
KS068002006OtherMEDICARE PTAN
330230OtherFIRST GUARD
110200508Medicare ID - Type UnspecifiedRR MCR
MOI145789AMedicare ID - Type Unspecified