Provider Demographics
NPI:1306888342
Name:CHIANG, MICHAEL C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:CHIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1142
Mailing Address - Country:US
Mailing Address - Phone:214-395-8858
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY
Practice Address - Street 2:SUITE #302
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5151
Practice Address - Country:US
Practice Address - Phone:972-859-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113256515Medicaid
TX113256501Medicaid
TXTX131786Medicare PIN
TXG60086Medicare UPIN
TX00059MMedicare PIN