Healthcare Provider Details

I. General information

NPI: 1770579294
Provider Name (Legal Business Name): SIGMUND M CHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 HICKORY LN
PEPPER PIKE OH
44124-4211
US

IV. Provider business mailing address

PO BOX 25730
GARFIELD HTS OH
44125-0730
US

V. Phone/Fax

Practice location:
  • Phone: 216-475-3332
  • Fax: 216-475-3350
Mailing address:
  • Phone: 216-475-3332
  • Fax: 216-475-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35033134
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: