Healthcare Provider Details

I. General information

NPI: 1821023003
Provider Name (Legal Business Name): MICHAEL J CHANEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 RANCH ROAD 620 S STE 130
LAKEWAY TX
78734-3966
US

IV. Provider business mailing address

2935 THOUSAND OAKS DR STE 294
SAN ANTONIO TX
78247-3563
US

V. Phone/Fax

Practice location:
  • Phone: 512-614-4111
  • Fax: 512-614-4183
Mailing address:
  • Phone: 210-494-1100
  • Fax: 210-494-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberE4248
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberE4248
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberE4248
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: