Provider Demographics
NPI:1720602188
Name:MICHAEL P CHAN, MD, MS, RST, INC
Entity Type:Organization
Organization Name:MICHAEL P CHAN, MD, MS, RST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-646-0984
Mailing Address - Street 1:3726 LAS VEGAS BLVD S UNIT 3501W
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89158-4399
Mailing Address - Country:US
Mailing Address - Phone:408-646-0984
Mailing Address - Fax:
Practice Address - Street 1:2345 SPRUCE GOOSE ST # C234
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2625
Practice Address - Country:US
Practice Address - Phone:408-646-0984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty