Healthcare Provider Details

I. General information

NPI: 1568616787
Provider Name (Legal Business Name): CHU RI SHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

1111 HIGHLAND AVE WIMR 4151
MADISON WI
53705-2275
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6200
  • Fax: 608-265-9721
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number56736
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: