MEDICARE: CHIN YI 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	4301074619	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CY074619	OTHER	MI	MEDICAL LICENSE

General Provider Information

NPI Number	:	1649259532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIN YI MD

Provider Business Mailing Address
First Line	:	15500 LUNDY PKWY
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2778
Country	:	US
Telephone Number	:	313-586-5011
Fax Number	:	313-792-7134

Provider Business Practice Location Address
First Line	:	201 3RD ST
Second Line	:	SUITE 300
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2605
Country	:	US
Telephone Number	:	734-697-9055
Fax Number	:

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	10/27/2014

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Directions to “ CHIN YI MD” Practice Location

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