Provider Demographics
NPI:1972597938
Name:GO, JANICE CHUA (MD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:CHUA
Last Name:GO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3585 LEXINGTON AVE N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8064
Mailing Address - Country:US
Mailing Address - Phone:651-251-5280
Mailing Address - Fax:651-251-5282
Practice Address - Street 1:3585 LEXINGTON AVE N
Practice Address - Street 2:SUITE 350
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8064
Practice Address - Country:US
Practice Address - Phone:651-484-3942
Practice Address - Fax:651-787-0519
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN418942080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1203069OtherMEDICA
MN299L6GOOtherBLUE CROSS BLUE SHIELD
MN071695200Medicaid
MNCP9091022251OtherPREFERRED ONE
MN1202358OtherMEDICA
MN1203069OtherMEDICA