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General NPI Number Information
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NPI Number | 1407811870
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Entity Type | Individual
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Provider Name | MARLON R CHAGUA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 4001 KRESGE WAY STE 236
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City | LOUISVILLE
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State | KY
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Zip | 40207-4640
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Country | US
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Telephone | 502-893-7372
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Fax | 502-409-4715
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Provider Business Mailing Address
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Address Line | 4001 KRESGE WAY STE 236
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City | LOUISVILLE
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State | KY
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Zip | 40207-4640
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Country | US
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Telephone | 502-893-7372
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Fax | 502-409-4715
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 36325
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License Number State | KY
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