Basic Information
| Provider Information | |||||||||
| NPI: | 1942267802 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KWAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8201 EWING HALSELL | ||||||||
| Address2: | MEZZANINE FLOOR | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758514 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4499 MEDICAL DR | ||||||||
| Address2: | SUITE 166 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758514 | ||||||||
| FaxNumber: | 2105758647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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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 | 207RC0000X | L4509 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P00692817 | 01 | TX | R.ROAD | OTHER | 161039605 | 01 | TX | CSN | OTHER | 161039604 | 05 | TX | MEDICAID | 8BX126 | 01 | TX | BCBS | OTHER |