Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | IL |
NPI | 1043250954 |
---|---|
Provider Name | Dr. Chae Chu |
First Address | Normal, IL 61761-3551 |
Second Address | Normal, IL 61761-3551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017329 | HEALTH ALLIANCE (01) | IL |
05732097 | BC GROUP NUMBER (01) | IL |
G03592 | (02) |