Provider Demographics
NPI:1043325848
Name:HSU, MICHAEL CHANG-CHI (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHANG-CHI
Last Name:HSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 HEALTH PARK BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5796
Mailing Address - Country:US
Mailing Address - Phone:904-824-4277
Mailing Address - Fax:904-824-4490
Practice Address - Street 1:201 HEALTH PARK BLVD
Practice Address - Street 2:STE 107
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5796
Practice Address - Country:US
Practice Address - Phone:904-824-4277
Practice Address - Fax:904-824-4490
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99434208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery