Healthcare Provider Details

I. General information

NPI: 1548356967
Provider Name (Legal Business Name): BRIAN CHUN-WAH LAW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 ROCKSIDE RD STE 350
INDEPENDENCE OH
44131-2351
US

IV. Provider business mailing address

9200 W WISCONSIN AVE DEPARTMENT OF ORTHOPAEDIC SURGERY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 216-369-2830
  • Fax: 216-642-0070
Mailing address:
  • Phone: 414-805-7410
  • Fax: 414-805-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number49464-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.148480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: