Individual
MIRIAM R CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10080 BALAYE RUN DR, TAMPA, FL 33619-7902
(813) 490-6100
Mailing address
8994 PROVINCE ST, SARASOTA, FL 34240-8311
(407) 319-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME115766
FL
207LP3000X
Pediatric Anesthesiology Physician
Primary
ME115766
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010603200
—
FL
Enumeration date
03/31/2009
Last updated
03/17/2018
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