Provider Demographics
NPI:1669451597
Name:KUO, SU-CHIAO (MD)
Entity Type:Individual
Prefix:
First Name:SU-CHIAO
Middle Name:
Last Name:KUO
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 1:3724 CENTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:330-225-7733
Mailing Address - Fax:330-220-0902
Practice Address - Street 1:3724 CENTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:330-225-7733
Practice Address - Fax:330-220-0902
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052983207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0685950Medicaid
C03296Medicare UPIN
OH0685950Medicaid