Healthcare Provider Details

I. General information

NPI: 1497739288
Provider Name (Legal Business Name): MICHAL CHIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 DEWEY ST
MANITOWOC WI
54220-5497
US

IV. Provider business mailing address

4100 DEWEY ST
MANITOWOC WI
54220-5497
US

V. Phone/Fax

Practice location:
  • Phone: 920-686-5700
  • Fax:
Mailing address:
  • Phone: 920-686-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37522
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier37522
Identifier TypeOTHER
Identifier StateWV
Identifier IssuerLICENSE
# 2
Identifier32550900
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: