Individual
MICHAEL CHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 446-4695
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
RN9397808
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9397808
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021786300
—
FL
05
—
300026388
—
IN
01
—
815500617
MEDICARE PTAN
IN
Enumeration date
04/07/2017
Last updated
02/09/2024
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