Provider Demographics
NPI:1528040862
Name:CHU, BETTY S W (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:S W
Last Name:CHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6483 CITATION DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2994
Mailing Address - Country:US
Mailing Address - Phone:248-922-0856
Mailing Address - Fax:248-922-9368
Practice Address - Street 1:6483 CITATION DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2994
Practice Address - Country:US
Practice Address - Phone:248-922-0856
Practice Address - Fax:248-922-9368
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066116207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OF37697105Medicare ID - Type Unspecified
G97175Medicare UPIN