Healthcare Provider Details

I. General information

NPI: 1417025859
Provider Name (Legal Business Name): DENISE MICHELLE CHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE M CHAN MD

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

601 5TH ST S 5TH FLOOR, DEPT. 6941
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 530-324-2678
  • Fax:
Mailing address:
  • Phone: 530-324-2678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA122571
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-142009
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME108121
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number224859
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME108121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: