MEDICARE: DR. WIEN 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
1	207Q00000X	Family Medicine Physician	154566	FL

General Provider Information

NPI Number	:	1427616036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WIEN CHAN MD

Provider Business Mailing Address
First Line	:	5937 BENEVA RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34238-2504
Country	:	US
Telephone Number	:	941-918-2011
Fax Number	:	941-210-3610

Provider Business Practice Location Address
First Line	:	5937 BENEVA RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34238-2504
Country	:	US
Telephone Number	:	941-918-2011
Fax Number	:	941-210-3610

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

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	10/19/2022

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