Healthcare Provider Details

I. General information

NPI: 1033150511
Provider Name (Legal Business Name): MS. MEI CHUN CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SAINT CLAIR RIVER DR
ALGONAC MI
48001-1802
US

IV. Provider business mailing address

240 HURON LN
MARINE CITY MI
48039-1434
US

V. Phone/Fax

Practice location:
  • Phone: 810-794-7548
  • Fax:
Mailing address:
  • Phone: 810-765-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085576
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: