Provider Demographics
NPI:1033291935
Name:CHIU, SIMON S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:S
Last Name:CHIU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 PICADILLY LN APT 7
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3874
Mailing Address - Country:US
Mailing Address - Phone:419-482-6445
Mailing Address - Fax:
Practice Address - Street 1:600 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9038
Practice Address - Country:US
Practice Address - Phone:419-599-1660
Practice Address - Fax:419-592-8336
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0679432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.067943OtherMEDICAL LICENSE#
OH2116570Medicaid
BC4497536OtherDEA REGISTRATION#
OHG39920Medicare UPIN
BC4497536OtherDEA REGISTRATION#