MEDICARE: MR. SIGMUND M CHA MD

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	2084P0800X	Psychiatry Physician	35033134	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	346696706002	OTHER	OH	MEDICAL MUTUAL

General Provider Information

NPI Number	:	1770579294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIGMUND M CHA MD

Provider Business Mailing Address
First Line	:	PO BOX 25730
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-0730
Country	:	US
Telephone Number	:	216-475-3332
Fax Number	:	216-475-3350

Provider Business Practice Location Address
First Line	:	2590 HICKORY LN
Second Line	:
City	:	PEPPER PIKE
State	:	OH
Zip	:	44124-4211
Country	:	US
Telephone Number	:	216-475-3332
Fax Number	:	216-475-3350

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/08/2007

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