Provider Demographics
NPI:1407872351
Name:CHUA, SERAFIN (MD)
Entity Type:Individual
Prefix:
First Name:SERAFIN
Middle Name:
Last Name:CHUA
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 1:2653 W OGDEN AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1647
Mailing Address - Country:US
Mailing Address - Phone:773-257-6730
Mailing Address - Fax:773-257-4775
Practice Address - Street 1:2653 W OGDEN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1647
Practice Address - Country:US
Practice Address - Phone:773-257-6730
Practice Address - Fax:773-257-4775
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15019207P00000X
IL036091861207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091861Medicaid
ILL90371Medicare PIN
IL036091861Medicaid
367830Medicare PIN