Provider Demographics
NPI:1538157995
Name:CHU, MICHELLE K (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:CHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5000
Mailing Address - Fax:775-789-3900
Practice Address - Street 1:1500 E 2ND ST
Practice Address - Street 2:SUITE 206
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1181
Practice Address - Country:US
Practice Address - Phone:775-789-7000
Practice Address - Fax:775-789-7040
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11107208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11343184OtherCAQH NUMBER
NV11107OtherNV MD LICENSE
CAXPY201520Medicaid
NV100503904Medicaid
CAXPY201520Medicaid
NV100503904Medicaid
NVV83056Medicare PIN
NVI13664Medicare UPIN