MEDICARE: RODRIGO C CHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	29915	AZ
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	29915	AZ
3	207U00000X	Nuclear Medicine Physician	29915	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00086778	OTHER	AZ	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659349512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODRIGO C CHAN MD

Provider Business Mailing Address
First Line	:	6709 E SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3738
Country	:	US
Telephone Number	:	480-773-2220
Fax Number	:	480-378-2440

Provider Business Practice Location Address
First Line	:	6709 E SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3738
Country	:	US
Telephone Number	:	480-773-2220
Fax Number	:	480-378-2440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	10/08/2025

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Directions to “ RODRIGO C CHAN MD” Practice Location

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