Provider Demographics
NPI:1730259714
Name:CHUNGA, JOHN PETER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:CHUNGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14186 STONEHURST CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4861
Mailing Address - Country:US
Mailing Address - Phone:574-271-9999
Mailing Address - Fax:
Practice Address - Street 1:801 E. LASALLE AVE.
Practice Address - Street 2:ST. JOSEPH REGIONAL MEDICAL CENTER
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617
Practice Address - Country:US
Practice Address - Phone:574-233-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064029A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF33642Medicare UPIN
IN169130YMedicare PIN