Provider Demographics
NPI:1447214572
Name:CHAN, SIU-MEI (MD)
Entity Type:Individual
Prefix:DR
First Name:SIU-MEI
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 NW 53RD ST STE 450
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4837
Mailing Address - Country:US
Mailing Address - Phone:786-805-4100
Mailing Address - Fax:855-252-4443
Practice Address - Street 1:8333 NW 53RD ST STE 450
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:786-805-4100
Practice Address - Fax:855-252-4443
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-5557C208600000X
FLME100289208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2216846Medicaid
FLPENDINGMedicaid
OHH19698Medicare UPIN
FLPENDINGMedicare UPIN
FLPENDINGMedicaid
OH2216846Medicaid