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General NPI Number Information
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NPI Number | 1477583573
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Entity Type | Organization
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Legal Business Name | DAVID B CHUA, MD, SC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2600 N MAYFAIR RD SUITE 670
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City | WAUWATOSA
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State | WI
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Zip | 53226-1309
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Country | US
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Telephone | 414-933-9851
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Fax | 414-933-1050
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Provider Business Mailing Address
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Address Line | 2600 N MAYFAIR RD SUITE 670
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City | WAUWATOSA
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State | WI
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Zip | 53226-1309
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Country | US
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Telephone | 414-933-9851
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Fax | 414-933-1050
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID B CHUA
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Credential | M.D.
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Telephone | 414-933-9851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 20501
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License Number State | WI
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