Provider Demographics
NPI:1992913685
Name:HU, EDWARD H (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:HU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6200
Mailing Address - Fax:641-752-7420
Practice Address - Street 1:1195 BOYSON RD STE 200
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2218
Practice Address - Country:US
Practice Address - Phone:319-362-8032
Practice Address - Fax:319-362-6098
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008622207W00000X
MDD0070436207W00000X
IA40287207W00000X
IL036-130628207W00000X
IA47668207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1992913685Medicaid
IA1992913685Medicaid
IA0060350OtherIOWA GROUP MEDICAID
IL36130628Medicaid
IL790730OtherILLINOIS GROUP MEDICARE
MD4200934Medicaid
IL790730OtherILLINOIS GROUP MEDICARE