MEDICARE: DR. DAVID S 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	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1629279948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S CHAN M.D.

Provider Business Mailing Address
First Line	:	3616 S NORMAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1722
Country	:	US
Telephone Number	:	773-624-6166
Fax Number	:

Provider Business Practice Location Address
First Line	:	3616 S NORMAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1722
Country	:	US
Telephone Number	:	773-624-6166
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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