Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35-07-6821 | OH |
NPI | 1205826161 |
---|---|
Provider Name | Dr. Peter Shin Cha |
First Address | Cincinnati, OH 45241-1018 |
Second Address | Cincinnati, OH 45247-7961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 09/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000320048 | ANTHEM (01) | OH |
2475610 | (05) | OH |
409406 | WELLCARE (01) | OH |
7395549 | AETNA (01) | OH |
76821 | HUMANA (01) | OH |
I06683 | (02) | OH |