Provider Demographics
NPI:1396738233
Name:CHENG, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8481
Practice Address - Country:US
Practice Address - Phone:219-757-6322
Practice Address - Fax:219-757-5891
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093981207ZP0102X
IN01050183A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000649197OtherBC/BS
IN5497426002OtherCIGNA
IN351173213OtherHFN
IN5273524OtherCCN
INP00816099OtherRAILROAD MEDICARE
IL01630255OtherBCBC
IN200856740Medicaid
IN82435OtherBCBS
IN100162290Medicaid
IN100356620Medicaid
IN351173213OtherISPAT/INLAND
IN351173213OtherSAGAMORE
IN100356620Medicaid
IN100162290Medicaid
INP00816099OtherRAILROAD MEDICARE
IN351173213OtherISPAT/INLAND
IN351173213OtherHFN