Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 036-101920 | IL |
Y | 2081S0010X | Sports Medicine | 036-101920 | IL |
Y | 213ES0000X | Sports Medicine | 036-101920 | IL |
NPI | 1538450770 |
---|---|
Provider Name | Dr. Samuel Kwang-Wei Chu |
First Address | Chicago, IL 60611-3167 |
Second Address | Chicago, IL 60611-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2011 |
Last Update Date | 01/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036140570-1 | (05) | IL |
P01789506 | MEDICARE RAILROAD (01) | IL |