Provider Demographics
NPI:1528016342
Name:CHUA, ROWENA ARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROWENA
Middle Name:ARLENE
Last Name:CHUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1003
Mailing Address - Country:US
Mailing Address - Phone:847-440-4355
Mailing Address - Fax:
Practice Address - Street 1:1818 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1003
Practice Address - Country:US
Practice Address - Phone:847-491-1122
Practice Address - Fax:888-373-0816
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA394332084N0400X
IL36-1129262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1528016342Medicaid
IA719260217Medicare UPIN