Healthcare Provider Details

I. General information

NPI: 1275586760
Provider Name (Legal Business Name): THOMAS CHIAHO CHIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 W I 30
GARLAND TX
75043-5702
US

IV. Provider business mailing address

PO BOX 9101
COPPELL TX
75019-9494
US

V. Phone/Fax

Practice location:
  • Phone: 972-303-3030
  • Fax: 972-240-1223
Mailing address:
  • Phone: 972-745-7500
  • Fax: 972-471-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL6321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: