Healthcare Provider Details

I. General information

NPI: 1053356212
Provider Name (Legal Business Name): MARY ANNA CHIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

IV. Provider business mailing address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-2448
  • Fax: 509-482-2452
Mailing address:
  • Phone: 509-482-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number30922
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: