Healthcare Provider Details

I. General information

NPI: 1023075603
Provider Name (Legal Business Name): AUDREY CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: AUDREY GIANGIORGI

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W BELMONT AVE SUITE 103
CHICAGO IL
60657-7176
US

IV. Provider business mailing address

346 E CENTER AVE
LAKE BLUFF IL
60044-2506
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-1738
  • Fax: 773-472-7395
Mailing address:
  • Phone: 847-234-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: