Provider Demographics
NPI:1467871194
Name:CHUNG, MIMI MERRILLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:MERRILLYN
Last Name:CHUNG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1400 N. RITTER, #281 COMMUNITY EAST
Mailing Address - Street 2:COMMUNITY EYE CARE OF INDIANA, INC.
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219
Mailing Address - Country:US
Mailing Address - Phone:317-357-8663
Mailing Address - Fax:317-819-0775
Practice Address - Street 1:1400 N. RITTER, #281 COMMUNITY EAST
Practice Address - Street 2:COMMUNITY EYE CARE OF INDIANA, INC.
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219
Practice Address - Country:US
Practice Address - Phone:317-357-8663
Practice Address - Fax:317-819-0775
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2016-04-15
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Provider Licenses
StateLicense IDTaxonomies
IN01044788A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE36923Medicare UPIN