=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275731002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT A. CHUA, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2007
-----------------------------------------------------
Last Update Date | 08/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 E HOSPITAL LN SUITE 103
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-4230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-234-0293
-----------------------------------------------------
Fax | 812-235-8908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 E HOSPITAL LN SUITE 103
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-4230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-234-0293
-----------------------------------------------------
Fax | 812-235-8908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT A CHUA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 812-234-0293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 01052731A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------