Provider Demographics
NPI:1275731002
Name:ROBERT A. CHUA, MD INC
Entity Type:Organization
Organization Name:ROBERT A. CHUA, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-234-0293
Mailing Address - Street 1:501 E HOSPITAL LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4230
Mailing Address - Country:US
Mailing Address - Phone:812-234-0293
Mailing Address - Fax:812-235-8908
Practice Address - Street 1:501 E HOSPITAL LN
Practice Address - Street 2:SUITE 103
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4230
Practice Address - Country:US
Practice Address - Phone:812-234-0293
Practice Address - Fax:812-235-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052731A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200273740BMedicaid
INH22103Medicare UPIN