Provider Demographics
NPI:1407488943
Name:TAN AI, RICHMOND CHUA
Entity Type:Individual
Prefix:MR
First Name:RICHMOND
Middle Name:CHUA
Last Name:TAN AI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24901 NORTHWESTERN HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2200
Mailing Address - Country:US
Mailing Address - Phone:248-358-3000
Mailing Address - Fax:
Practice Address - Street 1:24901 NORTHWESTERN HWY STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2200
Practice Address - Country:US
Practice Address - Phone:248-358-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist