Provider Demographics
NPI:1033150511
Name:CHAN, MEI CHUN
Entity Type:Individual
Prefix:MS
First Name:MEI
Middle Name:CHUN
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 HURON LN
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-1434
Mailing Address - Country:US
Mailing Address - Phone:810-765-5010
Mailing Address - Fax:
Practice Address - Street 1:555 SAINT CLAIR RIVER DR
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001-1802
Practice Address - Country:US
Practice Address - Phone:810-794-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010855761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1033150511Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER