Provider Demographics
NPI:1770579294
Name:CHA, SIGMUND M (MD)
Entity type:Individual
Prefix:MR
First Name:SIGMUND
Middle Name:M
Last Name:CHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 25730
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-0730
Mailing Address - Country:US
Mailing Address - Phone:216-475-3332
Mailing Address - Fax:216-475-3350
Practice Address - Street 1:2590 HICKORY LN
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-4211
Practice Address - Country:US
Practice Address - Phone:216-475-3332
Practice Address - Fax:216-475-3350
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350331342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259974Medicaid
OH346696706002OtherMEDICAL MUTUAL
D31905Medicare UPIN
OH346696706002OtherMEDICAL MUTUAL