Basic Information
| Provider Information | |||||||||
| NPI: | 1033291935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIU | ||||||||
| FirstName: | SIMON | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1367 PICADILLY LN APT 7 | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435373874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194826445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 FREEDOM DR | ||||||||
| Address2: | |||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435459038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195991660 | ||||||||
| FaxNumber: | 4195928336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35.067943 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 35.067943 | 01 | OH | MEDICAL LICENSE# | OTHER | 2116570 | 05 | OH | MEDICAID | BC4497536 | 01 | DEA REGISTRATION# | OTHER |