Provider Demographics
NPI:1801168224
Name:CHAN, SAMSON (MD)
Entity type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:
Last Name:CHAN
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 1:474 N LAKE SHORE DR
Mailing Address - Street 2:APT 5206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6494
Mailing Address - Country:US
Mailing Address - Phone:773-966-9978
Mailing Address - Fax:
Practice Address - Street 1:553 W 31ST ST STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4992
Practice Address - Country:US
Practice Address - Phone:773-966-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093219208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery