Individual
GONZALO T CHUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, ROOM 1204A, INDIANAPOLIS, IN 46202-1239
(317) 962-6793
(317) 962-8281
Mailing address
714 N SENATE AVE, STE EF100, INDIANAPOLIS, IN 46202-3763
(317) 715-6402
(317) 715-6415
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
01021628
IN
2085R0202X
Diagnostic Radiology Physician
01021628
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000556651
ANTHEM BCBS
IN
05
—
100348850
—
IN
01
—
P00275181
RAILROAD MEDICARE
IN
01
—
P00742701
RAILROAD MEDICARE
IN
Enumeration date
06/14/2006
Last updated
02/25/2010
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