MEDICARE: DR. SHELLY ANN CHANG MD

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	207R00000X	Internal Medicine Physician	K5270	TX

General Provider Information

NPI Number	:	1790760445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLY ANN CHANG MD

Provider Business Mailing Address
First Line	:	3500 W WHEATLAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3460
Country	:	US
Telephone Number	:	214-947-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 W WHEATLAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-5012
Country	:	US
Telephone Number	:	214-947-6700
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	11/28/2007

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