MEDICARE: DR. LESLIE 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	32172	OK
2	207L00000X	Anesthesiology Physician	32172	OK

Other Identifiers

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

General Provider Information

NPI Number	:	1912039850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE CHAN MD

Provider Business Mailing Address
First Line	:	8131 S MEMORIAL DR STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4348
Country	:	US
Telephone Number	:	918-200-9944
Fax Number	:	877-616-3089

Provider Business Practice Location Address
First Line	:	8131 S MEMORIAL DR STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4348
Country	:	US
Telephone Number	:	918-200-9944
Fax Number	:	877-616-3089

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	09/17/2025

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