Healthcare Provider Details

I. General information

NPI: 1730675828
Provider Name (Legal Business Name): MICHAEL CHAVEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 02/11/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 KLAWOCK HOLLIS HIGHWAY
KLAWOCK AK
99925
US

IV. Provider business mailing address

PO BOX 69
KLAWOCK AK
99925-0069
US

V. Phone/Fax

Practice location:
  • Phone: 907-523-4300
  • Fax:
Mailing address:
  • Phone: 907-523-4300
  • Fax: 907-523-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10064482
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number23799
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number228101
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: