MEDICARE: IGMAR CHANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA 39363	FL

General Provider Information

NPI Number	:	1760516504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGMAR CHANG

Provider Business Mailing Address
First Line	:	3901 SW 109AVE APT G10
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165
Country	:	US
Telephone Number	:	305-300-8631
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 SW 109TH AVE
Second Line	:	APT G10
City	:	MIAMI
State	:	FL
Zip	:	33165-4438
Country	:	US
Telephone Number	:	305-300-8631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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Directions to “ IGMAR CHANG ” Practice Location

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