Provider Demographics
NPI:1023091972
Name:CHAN, ALEX CUA (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:CUA
Last Name:CHAN
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 1:3700 PARK EAST DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4399
Mailing Address - Country:US
Mailing Address - Phone:855-292-1401
Mailing Address - Fax:866-396-8340
Practice Address - Street 1:3700 PARK EAST DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4399
Practice Address - Country:US
Practice Address - Phone:855-292-1401
Practice Address - Fax:866-396-8340
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL232222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910994Medicaid
AL51595066OtherBCBS
AL51595459OtherBCBS
AL51055337OtherBCBS
AL55337Medicaid
AL51055334OtherBCBS
AL51100034OtherBCBS
AL009911527Medicaid
AL55334Medicaid
AL009942793Medicaid
AL55335Medicaid
AL55336Medicaid
AL51055335OtherBCBS
AL51055336OtherBCBS
AL51595458OtherBCBS
AL51595459OtherBCBS
AL51055336OtherBCBS