Healthcare Provider Details

I. General information

NPI: 1659367068
Provider Name (Legal Business Name): CHE-FU KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/03/2011
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

400 MATTHEW ST SUITE 204
MARIETTA OH
45750-1656
US

IV. Provider business mailing address

400 MATTHEW ST SUITE 204
MARIETTA OH
45750-1656
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-5360
  • Fax: 740-568-5359
Mailing address:
  • Phone: 740-568-5360
  • Fax: 740-568-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35074668K
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: