Provider Demographics
NPI:1972503423
Name:CHIU, CALVIN C (MD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:C
Last Name:CHIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2917
Mailing Address - Country:US
Mailing Address - Phone:618-244-6170
Mailing Address - Fax:618-244-7445
Practice Address - Street 1:2413 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2917
Practice Address - Country:US
Practice Address - Phone:618-244-6170
Practice Address - Fax:618-244-7445
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL113672OtherHEALTHLINK
ILL013912OtherTRICARE
IL113672OtherHEALTHLINK
IL735921Medicare ID - Type Unspecified