Healthcare Provider Details

I. General information

NPI: 1558557272
Provider Name (Legal Business Name): FRED F CHIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2007
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 BELLE CHASSE HWY SUITE I
TERRYTOWN LA
70056-7156
US

IV. Provider business mailing address

2600 BELLE CHASSE HWY SUITE I
TERRYTOWN LA
70056-7156
US

V. Phone/Fax

Practice location:
  • Phone: 504-391-7670
  • Fax: 504-378-9439
Mailing address:
  • Phone: 504-391-7670
  • Fax: 504-378-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.203843
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD.203843
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: