Provider Demographics
NPI:1790981413
Name:CHAU PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:CHAU PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:THUYENMY
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-799-2880
Mailing Address - Street 1:27901 WOODWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0919
Mailing Address - Country:US
Mailing Address - Phone:248-799-2880
Mailing Address - Fax:248-414-3959
Practice Address - Street 1:27901 WOODWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0919
Practice Address - Country:US
Practice Address - Phone:248-799-2880
Practice Address - Fax:248-414-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008859208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE14849OtherHAP
MI5631288OtherBLUE CARE NETWORK
MI4555188OtherAETNA
MI17035OtherMCARE
MI2456312884OtherBLUE CROSS BLUE SHIELD
MI5631288OtherBLUE CARE NETWORK
MI0P13140Medicare ID - Type UnspecifiedMEDICARE
MI2456312884OtherBLUE CROSS BLUE SHIELD