Provider Demographics
NPI:1821173444
Name:CHAU, BRUCE THUYENMY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:THUYENMY
Last Name:CHAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008859208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2456312884OtherBLUE CROSS BLUE SHIELD
MI5631288OtherBLUE CARE NETWORK
MI4555188OtherAETNA
MIE14849OtherHAP
MI17035OtherMCARE
MI17035OtherMCARE
MI2456312884OtherBLUE CROSS BLUE SHIELD
MI4555188OtherAETNA