Healthcare Provider Details

I. General information

NPI: 1790782472
Provider Name (Legal Business Name): PAULINO Y. CHAN, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MACARTHUR BLVD STE 21
MUNSTER IN
46321-2918
US

IV. Provider business mailing address

800 MACARTHUR BLVD STE 21
MUNSTER IN
46321-2918
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1163
  • Fax: 219-836-0588
Mailing address:
  • Phone: 219-836-1163
  • Fax: 219-836-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. PAULINO Y CHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 219-836-1163