Provider Demographics
NPI:1780653006
Name:CHASIN, MICHAEL ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ADAM
Last Name:CHASIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 S DOBSON RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4713
Mailing Address - Country:US
Mailing Address - Phone:480-834-0269
Mailing Address - Fax:480-834-0670
Practice Address - Street 1:1500 S DOBSON RD
Practice Address - Street 2:SUITE 315
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4713
Practice Address - Country:US
Practice Address - Phone:480-834-0269
Practice Address - Fax:480-834-0670
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ8082208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27894Medicare ID - Type Unspecified
AZD36663Medicare UPIN