MEDICARE: CYNTHIA CHOW, M.D., P.C.

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	207N00000X	Dermatology Physician	4301025962	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0706313891	OTHER	MI	BLUE CROSS BLUE SHIELD MI

General Provider Information

NPI Number	:	1477634467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA CHOW, M.D., P.C.

Provider Business Mailing Address
First Line	:	1419 WALTON BLVD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1775
Country	:	US
Telephone Number	:	248-651-1001
Fax Number	:	248-651-1002

Provider Business Practice Location Address
First Line	:	1419 WALTON BLVD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1775
Country	:	US
Telephone Number	:	248-651-1001
Fax Number	:	248-651-1002

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CYNTHIA CHOW
Credential	:	M.D.
Telephone Number	:	248-651-1001

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/24/2009

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