Healthcare Provider Details

I. General information

NPI: 1912021726
Provider Name (Legal Business Name): MIGUEL CUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 W FULLERTON AVE
CHICAGO IL
60647
US

IV. Provider business mailing address

PO BOX 478499 FULLERTON KIMBALL MED GROUP
CHICAGO IL
60647
US

V. Phone/Fax

Practice location:
  • Phone: 773-235-8000
  • Fax:
Mailing address:
  • Phone: 773-235-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: