Provider Demographics
NPI:1659367068
Name:KUO, CHE-FU (MD)
Entity Type:Individual
Prefix:
First Name:CHE-FU
Middle Name:
Last Name:KUO
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 1:400 MATTHEW ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1656
Mailing Address - Country:US
Mailing Address - Phone:740-568-5360
Mailing Address - Fax:740-568-5359
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-568-5360
Practice Address - Fax:740-568-5359
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-04-03
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
OH35074668K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6000358000Medicaid
OH2121162Medicaid
OH2121162Medicaid
OH0881411Medicare PIN