Healthcare Provider Details

I. General information

NPI: 1992061519
Provider Name (Legal Business Name): CHEN THAY CHAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HARVARD ST SE
MINNEAPOLIS MN
55455-0363
US

IV. Provider business mailing address

500 HARVARD ST SE
MINNEAPOLIS MN
55455-0363
US

V. Phone/Fax

Practice location:
  • Phone: 612-964-4697
  • Fax:
Mailing address:
  • Phone: 612-964-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number61013
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number61013
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: