Healthcare Provider Details

I. General information

NPI: 1295719797
Provider Name (Legal Business Name): DEREK T CHEUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 WINDSOR CT SUITE 8
ELKHART IN
46514-5555
US

IV. Provider business mailing address

541 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

V. Phone/Fax

Practice location:
  • Phone: 574-266-7817
  • Fax: 574-266-7943
Mailing address:
  • Phone: 219-934-5300
  • Fax: 219-934-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01049198A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: