Provider Demographics
NPI:1528036423
Name:CHU, MARK Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:Y
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:333 EAST 2ND STREET
Mailing Address - Street 2:REGIONAL MEDICAL FACILITY
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153
Mailing Address - Country:US
Mailing Address - Phone:308-284-9838
Mailing Address - Fax:308-284-4120
Practice Address - Street 1:333 EAST 2ND STREET
Practice Address - Street 2:REGIONAL MEDICAL FACILITY
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-3421
Practice Address - Country:US
Practice Address - Phone:308-284-9838
Practice Address - Fax:308-284-4120
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2008-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE21559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470767637-13Medicaid
275998Medicare ID - Type Unspecified
F58255Medicare UPIN