Provider Demographics
NPI:1376539791
Name:CHOU, KELVIN LIN-YU (MD)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:LIN-YU
Last Name:CHOU
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 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:4260 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2700
Practice Address - Country:US
Practice Address - Phone:734-764-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11423174400000X
MI43010911162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29880OtherNEIGHBORHOOD HEALTH
RI050513332OtherUNITED HEALTHCARE
RI050513332OtherOXFORD
RI1376539791OtherNPI
RI411652OtherBLUE CHIP
RI29649OtherBLUECROSS BLUESHIELD RI
RI050513332OtherPHCS
RI050513332OtherTRICARE
RI3957622OtherAETNA
RI469157OtherTUFTS
RI7056733Medicaid
RI2113376OtherMASSHEATLH
RIAA29804OtherPILGRIM
RI411652OtherBLUE CHIP
RI3957622OtherAETNA
RI050513332OtherOXFORD