Provider Demographics
NPI:1619926011
Name:CHEN, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N 10TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1487
Mailing Address - Country:US
Mailing Address - Phone:503-769-7151
Mailing Address - Fax:503-769-9316
Practice Address - Street 1:1401 N 10TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1487
Practice Address - Country:US
Practice Address - Phone:503-769-7151
Practice Address - Fax:503-769-9316
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151266Medicaid
G77029Medicare UPIN
R102210Medicare PIN
OR110172941Medicare PIN