Provider Demographics
NPI:1487603312
Name:ALONSO, MISAEL CHAEN (MD)
Entity type:Individual
Prefix:DR
First Name:MISAEL
Middle Name:CHAEN
Last Name:ALONSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14955 W BELL RD UNIT 9080
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8285
Mailing Address - Country:US
Mailing Address - Phone:623-628-9349
Mailing Address - Fax:623-691-8178
Practice Address - Street 1:14955 W BELL RD UNIT 9080
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8285
Practice Address - Country:US
Practice Address - Phone:623-628-9349
Practice Address - Fax:623-691-8178
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31568207R00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ991879Medicaid
AZP00030851Medicare PIN
AZ991879Medicaid
AZZ75353Medicare PIN
AZZ75354Medicare PIN