Provider Demographics
NPI:1376579706
Name:CHAN, TZE Y (DO)
Entity Type:Individual
Prefix:DR
First Name:TZE
Middle Name:Y
Last Name:CHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 4TH AVE E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3155
Mailing Address - Country:US
Mailing Address - Phone:641-792-2112
Mailing Address - Fax:641-792-8484
Practice Address - Street 1:300 N 4TH AVE E
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3155
Practice Address - Country:US
Practice Address - Phone:641-792-2112
Practice Address - Fax:641-792-8484
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4071860Medicaid
IAE79879Medicare UPIN
IA12260Medicare ID - Type Unspecified