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Michelle Chan

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NPI Number Detailed Information

Provider Information:

Name: Michelle Chan
Gender: F
Provider License Number If Given:

NPI Information:

NPI: 1942294442
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 3241 S MICHIGAN AVE
Chicago, IL 60616
Phone Number: 3129497000
Fax Number: 3129497642

Provider Business Practice Location Address:

Address: 3241 S MICHIGAN AVE
Chicago, IL 60616
Phone Number: 3122256200
Fax Number: 3129497660

Provider Taxonomy:

Primary: 152W00000X
Secondary (if any):
State: IL

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