Provider Demographics
NPI:1043250954
Name:CHU, CHAE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAE
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 FRANKLIN AVE
Mailing Address - Street 2:#4500
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3551
Mailing Address - Country:US
Mailing Address - Phone:309-662-9631
Mailing Address - Fax:309-662-4706
Practice Address - Street 1:1302 FRANKLIN AVE
Practice Address - Street 2:#2200
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3551
Practice Address - Country:US
Practice Address - Phone:309-662-9631
Practice Address - Fax:309-662-4706
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL017329OtherHEALTH ALLIANCE
IL05732097OtherBC GROUP NUMBER
IL212636Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILK23121Medicare ID - Type Unspecified
ILP00271754Medicare ID - Type UnspecifiedRR MEDICARE NUMBER
IL05732097OtherBC GROUP NUMBER