MEDICARE: MICHAEL MIN CHU DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12013823A	IN

General Provider Information

NPI Number	:	1508594003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MIN CHU DMD

Provider Business Mailing Address
First Line	:	3408 FAIRWOOD DR
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2236 N MITTHOEFFER RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2803
Country	:	US
Telephone Number	:	317-897-5093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	06/25/2023

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