Healthcare Provider Details

I. General information

NPI: 1821085622
Provider Name (Legal Business Name): BENJAMIN CHIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BOULEVARD
KOKOMO IN
46902-6079
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 765-776-3900
  • Fax: 765-453-8050
Mailing address:
  • Phone: 765-456-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01048769A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: