Provider Demographics
NPI:1013923846
Name:CHUA, WINSTON (MD)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:
Last Name:CHUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 KENTUCKY AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3814
Mailing Address - Country:US
Mailing Address - Phone:270-444-3930
Mailing Address - Fax:270-442-5284
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3814
Practice Address - Country:US
Practice Address - Phone:270-444-3930
Practice Address - Fax:270-442-5284
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22568207RH0003X
KY41261207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051530906OtherBC ATHENS
AL009933001Medicaid
AL009982110Medicaid
KY000000537103OtherANTHEM
AL051507516OtherBC DECATUR
AL051507516Medicare ID - Type UnspecifiedDECATUR
KY000000537103OtherANTHEM
AL009982110Medicaid