Healthcare Provider Details

I. General information

NPI: 1326211640
Provider Name (Legal Business Name): CHIA-YANG LU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHIA-YANG JEFFREY LU MD

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST SUITE 10-548
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

676 N SAINT CLAIR ST SUITE 10-548
CHICAGO IL
60611-2927
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.115448
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-115448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: