Healthcare Provider Details

I. General information

NPI: 1770522989
Provider Name (Legal Business Name): SANDRA A CHO D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 CLEVELAND RD
SOUTH BEND IN
46628-3529
US

IV. Provider business mailing address

710 N NILES AVE
SOUTH BEND IN
46617-1924
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-4530
  • Fax: 574-647-2285
Mailing address:
  • Phone: 574-647-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000825A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: