Provider Demographics
NPI:1487073730
Name:CHAN, MALLORY MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:MICHELLE
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1700 WHEELING ST
Mailing Address - Street 2:PRIMARY CARE E2
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-399-8020
Mailing Address - Fax:303-340-8157
Practice Address - Street 1:1700 WHEELING ST
Practice Address - Street 2:PRIMARY CARE E2
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-399-8020
Practice Address - Fax:303-340-8157
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2024-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0056389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine