Healthcare Provider Details

I. General information

NPI: 1053364216
Provider Name (Legal Business Name): YURI CHUKA, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N
ALLEN TX
75013-6103
US

IV. Provider business mailing address

PO BOX 671013
DALLAS TX
75367-1013
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-1000
  • Fax:
Mailing address:
  • Phone: 972-234-6600
  • Fax: 972-234-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL1546
License Number StateTX

VIII. Authorized Official

Name: MS. RHONDA WRYE
Title or Position: BUSINESS OFFICE ADMINISTRATOR
Credential:
Phone: 972-234-6600