Healthcare Provider Details

I. General information

NPI: 1942267802
Provider Name (Legal Business Name): MICHAEL D. KWAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4499 MEDICAL DR SUITE 166
SAN ANTONIO TX
78229-3735
US

IV. Provider business mailing address

8201 EWING HALSELL MEZZANINE FLOOR
SAN ANTONIO TX
78229-3707
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-8514
  • Fax: 210-575-8647
Mailing address:
  • Phone: 210-575-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberL4509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: