MEDICARE: DR. PETER SHIN CHA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	35-07-6821	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	409406	OTHER	OH	WELLCARE
2	000000320048	OTHER	OH	ANTHEM
3	7395549	OTHER	OH	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	76821	OTHER	OH	HUMANA

General Provider Information

NPI Number	:	1205826161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER SHIN CHA M.D.

Provider Business Mailing Address
First Line	:	500 E-BUSINESS WAY
Second Line	:	SUITE A
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1018
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-354-3705

Provider Business Practice Location Address
First Line	:	6480 HARRISON AVE
Second Line	:	SUITE 201
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7961
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-354-7651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/09/2014

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Directions to “ DR. PETER SHIN CHA M.D.” Practice Location

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