Healthcare Provider Details

I. General information

NPI: 1245209246
Provider Name (Legal Business Name): CHENG DU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 ST FRANCIS DR
CROWN POINT IN
46307-0264
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-757-6121
  • Fax: 219-681-6897
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01055815A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA09009900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01055815A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9396994
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerPHCS PID NUMBER
# 2
Identifier000000221796
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM PROVIDER NUMBER
# 3
Identifier200376880
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 4
Identifier11383713
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerCAQH NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: