Provider Demographics
NPI:1659322048
Name:CHAN, MICAH R (MD)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:R
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3034 FISH HATCHERY RD STE B
Practice Address - Street 2:UW NEPHROLOGY
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3125
Practice Address - Country:US
Practice Address - Phone:608-270-5656
Practice Address - Fax:608-262-5624
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI43232207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology