MEDICARE: MICHAEL P CHAN, MD, MS, RST, INC

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1720602188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL P CHAN, MD, MS, RST, INC

Provider Business Mailing Address
First Line	:	3726 LAS VEGAS BLVD S UNIT 3501W
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89158-4399
Country	:	US
Telephone Number	:	408-646-0984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 SPRUCE GOOSE ST # C234
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2625
Country	:	US
Telephone Number	:	408-646-0984
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MICHAEL PHILIP CHAN
Credential	:	MD
Telephone Number	:	408-646-0984

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	06/02/2020

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