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NPI Code Detail

MEDICARE: DR. EDWIN CHAN MD

MEDICARE: DR. EDWIN CHAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME104439FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1VB775OTHERFLMEDICARE HF

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124142054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWIN CHAN MD
Provider Business Mailing Address
First Line : 3300 S FISKE BLVD
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-4306
Country : US
Telephone Number : 321-576-0645
Fax Number :
Provider Business Practice Location Address
First Line : 1810 ELDRON BLVD SE
Second Line :
City : PALM BAY
State : FL
Zip : 32909-6831
Country : US
Telephone Number : 321-576-0645
Fax Number : 321-409-6812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2007
Last Update Date : 09/11/2025

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