Provider Demographics
NPI:1730139494
Name:CHU, LINDA WILKINS (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:WILKINS
Last Name:CHU
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 1:3535 SOUTHERN BLVD.
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-395-8849
Mailing Address - Fax:937-395-8350
Practice Address - Street 1:3535 SOUTHERN BLVD.
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-395-8849
Practice Address - Fax:937-395-8350
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044699207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0517855Medicaid
E91888Medicare UPIN
OHE99188Medicare UPIN
OH0517855Medicaid