Basic Information
Provider Information
NPI: 1073749867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHIN
FirstName: MICHAEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD, MPH
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3841 GREEN HILLS VILLAGE DR STE 200
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372152691
CountryCode: US
TelephoneNumber: 6159360955
FaxNumber:  
Practice Location
Address1: 1211 21ST AVE S STE 640
Address2:  
City: NASHVILLE
State: TN
PostalCode: 37212
CountryCode: US
TelephoneNumber: 6159360955
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/08/2009
LastUpdateDate: 03/24/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/24/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X57753TNN Allopathic & Osteopathic PhysiciansInternal Medicine 
2083X0100X57753TNY Allopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine

No ID Information.


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