Individual
DAVID P CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-3453
(309) 655-3410
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
036122927
IL
2080P0202X
Pediatric Cardiology Physician
35 063194
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107855000
—
WV
05
—
0883147
—
OH
01
—
216946
MEDICARE GROUP
IL
05
—
6493002700
—
KY
Enumeration date
07/20/2005
Last updated
03/30/2022
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