Provider Demographics
NPI:1689647646
Name:CHUA, THOMAS YU (MD,)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:YU
Last Name:CHUA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4600 W LOOMIS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4858
Mailing Address - Country:US
Mailing Address - Phone:414-281-9665
Mailing Address - Fax:414-281-9674
Practice Address - Street 1:4600 W LOOMIS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-4858
Practice Address - Country:US
Practice Address - Phone:414-281-9665
Practice Address - Fax:414-281-9674
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21176020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30102800Medicaid
WIB52079Medicare UPIN