Provider Demographics
NPI:1790782472
Name:PAULINO Y. CHAN, MD, INC
Entity Type:Organization
Organization Name:PAULINO Y. CHAN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINO
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-1163
Mailing Address - Street 1:800 MACARTHUR BLVD
Mailing Address - Street 2:STE 21
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2918
Mailing Address - Country:US
Mailing Address - Phone:219-836-1163
Mailing Address - Fax:219-836-0588
Practice Address - Street 1:800 MACARTHUR BLVD
Practice Address - Street 2:STE 21
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2918
Practice Address - Country:US
Practice Address - Phone:219-836-1163
Practice Address - Fax:219-836-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C25011Medicare UPIN
IN455940Medicare ID - Type Unspecified