Provider Demographics
NPI:1952693301
Name:ELIZABETH TAN-CHIU MD PA
Entity Type:Organization
Organization Name:ELIZABETH TAN-CHIU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN-CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-582-1828
Mailing Address - Street 1:7542 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1317
Mailing Address - Country:US
Mailing Address - Phone:954-582-1815
Mailing Address - Fax:561-760-0265
Practice Address - Street 1:9980 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 114
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1762
Practice Address - Country:US
Practice Address - Phone:954-582-1815
Practice Address - Fax:954-582-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG78158Medicare UPIN
FLAC908Medicare PIN
FLE8814YMedicare PIN