Provider Demographics
NPI:1912069022
Name:CU CHIAM, ALAN KEH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEH
Last Name:CU CHIAM
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 1:10051 5TH STREET N.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-828-2370
Mailing Address - Fax:404-755-0520
Practice Address - Street 1:1188 RALPH DAVID ABERNATHY BLVD.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310
Practice Address - Country:US
Practice Address - Phone:404-755-8996
Practice Address - Fax:404-755-0520
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000718913DMedicaid
GAG87808Medicare UPIN
11BDQBVMedicare PIN