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General NPI Number Information
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NPI Number | 1821173444
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Entity Type | Individual
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Provider Name | BRUCE THUYENMY CHAU D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 27901 WOODWARD AVE SUITE 100
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City | BERKLEY
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State | MI
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Zip | 48072-0919
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Country | US
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Telephone | 248-799-2880
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Fax | 248-414-3959
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Provider Business Mailing Address
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Address Line | 27901 WOODWARD AVE SUITE 100
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City | BERKLEY
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State | MI
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Zip | 48072-0919
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Country | US
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Telephone | 248-799-2880
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Fax | 248-414-3959
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 5101008859
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License Number State | MI
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