Healthcare Provider Details

I. General information

NPI: 1174961916
Provider Name (Legal Business Name): THOMAS CHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD DEPARTMENT OF RADIOLOGY
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

4300 ALTON RD DEPARTMENT OF RADIOLOGY
MIAMI BEACH FL
33140-2948
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-7901
  • Fax: 305-674-3919
Mailing address:
  • Phone: 305-535-7901
  • Fax: 305-674-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN20603
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTRN20603
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME 128153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: