Provider Demographics
NPI:1417995564
Name:TSAI, EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:TSAI
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 1:3707 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1702
Mailing Address - Country:US
Mailing Address - Phone:260-484-0850
Mailing Address - Fax:260-484-5919
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-373-4731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055238A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12319OtherPHP
MI4386260100Medicaid
OH2383915Medicaid
IN000000208601OtherANTHEM
IN055740BBMedicare ID - Type Unspecified
IN924750YMedicare ID - Type Unspecified
IN194930PMedicare ID - Type Unspecified
IN925240AAMedicare ID - Type Unspecified
MI4386260100Medicaid
OHTS4111501Medicare ID - Type Unspecified
IN190320UMedicare ID - Type Unspecified
IN191150PMedicare ID - Type Unspecified
IN163520XMedicare ID - Type Unspecified
OH2383915Medicaid