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NPI Code Detail

MEDICARE: DAVID P CHAN MD

MEDICARE: DAVID P 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
12080P0202XPediatric Cardiology Physician35 063194OH
22080P0202XPediatric Cardiology Physician036122927IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4216946OTHERILMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427057595
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID P CHAN MD
Provider Business Mailing Address
First Line : 611 W. PARK ST.
Second Line : FAPC
City : URBANA
State : IL
Zip : 61801
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 420 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-655-3453
Fax Number : 309-655-3410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 03/30/2022

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Directions to “ DAVID P CHAN MD” Practice Location

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