Healthcare Provider Details

I. General information

NPI: 1700899622
Provider Name (Legal Business Name): JUSTIN CHOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUNMING ZOU

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST 1ST FL HOSPITALIST STE
SOUTH BEND IN
46601-1033
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-3500
  • Fax: 574-647-1094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01068196A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: