Provider Demographics
NPI:1942315023
Name:CHAN, ESTELA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTELA
Middle Name:L
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 1:145 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:RED CLOUD
Mailing Address - State:NE
Mailing Address - Zip Code:68970-2542
Mailing Address - Country:US
Mailing Address - Phone:402-746-3646
Mailing Address - Fax:402-746-3519
Practice Address - Street 1:145 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:RED CLOUD
Practice Address - State:NE
Practice Address - Zip Code:68970-2542
Practice Address - Country:US
Practice Address - Phone:402-746-3646
Practice Address - Fax:402-746-3519
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14917208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36303170800Medicaid
NEB67752Medicare UPIN
NE095068Medicare ID - Type Unspecified
NE36303170800Medicaid