Provider Demographics
NPI:1184678278
Name:TSAI, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:TSAI
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 1:109 CHESTNUT HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-8924
Mailing Address - Country:US
Mailing Address - Phone:260-918-2971
Mailing Address - Fax:260-918-1397
Practice Address - Street 1:109 CHESTNUT HILLS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-8924
Practice Address - Country:US
Practice Address - Phone:260-918-2971
Practice Address - Fax:260-918-1397
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010505302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10485OtherPHP
IN200224540Medicaid
OH2150505Medicaid
MI4115473100Medicaid
IN000000092596OtherANTHEM
IN055740WMedicare ID - Type Unspecified
MI4115473100Medicaid
IN000000092596OtherANTHEM
IN10485OtherPHP
ING71725Medicare UPIN
OH2150505Medicaid
IN925240UMedicare ID - Type Unspecified
IN924750TMedicare ID - Type Unspecified
IN190320RMedicare ID - Type Unspecified
IN300108000Medicare ID - Type UnspecifiedRAILROAD
IN147380DMedicare ID - Type Unspecified