MEDICARE: FELIPE ISIP CHUA JR. M.D., SA-C

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	246ZC0007X	Surgical Assistant	238.000366	IL

General Provider Information

NPI Number	:	1720214208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELIPE ISIP CHUA JR. M.D., SA-C

Provider Business Mailing Address
First Line	:	2158 45TH ST STE 204
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-3742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 W LEXINGTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607
Country	:	US
Telephone Number	:	219-218-2908
Fax Number	:

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

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	11/30/2020

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