1043222896 NPI number — MICHAEL A CHUNN MD

Table of content: MICHAEL A CHUNN MD (NPI 1043222896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043222896 NPI number — MICHAEL A CHUNN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNN
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043222896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6860 TYLERSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 12
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-701-3145
Provider Business Mailing Address Fax Number:
513-701-3146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6860 TYLERSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45040-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-701-3145
Provider Business Practice Location Address Fax Number:
513-701-3146
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  36326 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 35076823 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2183686 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311185270059 . This is a "HEALTH NET FEDERAL SERVIC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000530676 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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