Healthcare Provider Details

I. General information

NPI: 1598992562
Provider Name (Legal Business Name): BETH MARIE CHAN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12916 TRADD ST
CARMEL IN
46032-9500
US

IV. Provider business mailing address

12916 TRADD ST
CARMEL IN
46032-9500
US

V. Phone/Fax

Practice location:
  • Phone: 317-564-4140
  • Fax:
Mailing address:
  • Phone: 317-564-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: