MEDICARE: MICHELLE CHAN

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
1	2083A0100X	Aerospace Medicine Physician	R3866	TX
2	207P00000X	Emergency Medicine Physician	R3866	TX

General Provider Information

NPI Number	:	1154731222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CHAN

Provider Business Mailing Address
First Line	:	4810 N BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 KELLEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-1975
Country	:	US
Telephone Number	:	713-566-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/24/2026

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Directions to “ MICHELLE CHAN ” Practice Location

Language	Start Address	Practice Location

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