MEDICARE: EDWARD M CHAN M.D.

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	207RH0003X	Hematology & Oncology Physician	01043619	IN

General Provider Information

NPI Number	:	1538125927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD M CHAN M.D.

Provider Business Mailing Address
First Line	:	639 S DELAWARE ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-1392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1044 W WALNUT ST
Second Line	:	R4 202
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5254
Country	:	US
Telephone Number	:	317-508-2546
Fax Number	:

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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