Provider Demographics
NPI:1164414173
Name:HUANG, EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:HUANG
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 1:900 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514
Mailing Address - Country:US
Mailing Address - Phone:574-747-8004
Mailing Address - Fax:574-226-0795
Practice Address - Street 1:900 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514
Practice Address - Country:US
Practice Address - Phone:574-747-8004
Practice Address - Fax:574-226-0795
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044995207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103268226Medicaid
IN200102080AMedicaid
IN930035898OtherRAIL ROAD MEDICARE
IN000000082224OtherANTHEM
INF48105Medicare UPIN
IN000000082224OtherANTHEM