Provider Demographics
NPI:1316917172
Name:CHAN, SHEEYIP JOSIAH (DO)
Entity type:Individual
Prefix:
First Name:SHEEYIP
Middle Name:JOSIAH
Last Name:CHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 FRAN LIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3540
Mailing Address - Country:US
Mailing Address - Phone:219-836-1980
Mailing Address - Fax:219-836-2133
Practice Address - Street 1:911 FRAN LIN PKWY
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3540
Practice Address - Country:US
Practice Address - Phone:219-836-1980
Practice Address - Fax:219-836-2133
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001071207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100361560AMedicaid
IN100361560AMedicaid