Basic Information
| Provider Information | |||||||||
| NPI: | 1225236672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KWAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WYMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 261 DERBY ST UNIT A | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024651046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179237510 | ||||||||
| FaxNumber: | 8008047454 | ||||||||
| Practice Location | |||||||||
| Address1: | 1575 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021384308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178764344 | ||||||||
| FaxNumber: | 8008047454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A100528 | CA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 233494 | MA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1225236672 | 01 | MA | FALLON CHP | OTHER | 3664002 | 01 | MA | CIGNA | OTHER | 12656654 | 01 | MA | PHCS | OTHER | 9178208 | 01 | MA | AETNA | OTHER | 1225236672 | 01 | MA | TUFTS (COMMERCIAL) | OTHER | 45188 | 01 | MA | HEALTH NEW ENGLAND | OTHER | AA113632 | 01 | MA | HARVARD PILGRIM HP | OTHER | 95638907 | 01 | MA | NETWORK HEALTH | OTHER | J42759 | 01 | MA | BLUE CROSS BLUE SHIELD OF MASS | OTHER | 2146738 | 05 | MA | MEDICAID | 23-06065 | 01 | MA | EVERCARE | OTHER | 000000047181 | 01 | MA | BMC HEALTHNET | OTHER |