Individual
TRACEY E CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5555 CONNER ST, STE 2691, DETROIT, MI 48213-3448
(313) 579-1182
(313) 579-5128
Mailing address
5555 CONNER ST, STE 2691, DETROIT, MI 48213-3448
(313) 579-1182
(313) 579-5128
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704220570
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4956148
—
MI
Enumeration date
08/19/2006
Last updated
05/10/2011
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