Provider Demographics
NPI:1225117492
Name:CHUA-MANALO, INGRID JULIE YEO (MD)
Entity Type:Individual
Prefix:DR
First Name:INGRID JULIE
Middle Name:YEO
Last Name:CHUA-MANALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:29275 NORTHWESTERN HWY.
Mailing Address - Street 2:STE. 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-0000
Mailing Address - Country:US
Mailing Address - Phone:877-784-3667
Mailing Address - Fax:248-869-3982
Practice Address - Street 1:46325 W. TWELVE MILE RD.
Practice Address - Street 2:STE. 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-0000
Practice Address - Country:US
Practice Address - Phone:877-784-3667
Practice Address - Fax:248-869-3982
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064281208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4607165Medicaid
MI0007272058OtherAETNA PIN
MI4607165Medicaid
MI0007272058OtherAETNA PIN