Healthcare Provider Details

I. General information

NPI: 1407504327
Provider Name (Legal Business Name): ELIZABETH CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S CALIFORNIA AVE
CHICAGO IL
60608-1858
US

IV. Provider business mailing address

1853 W POLK ST
CHICAGO IL
60612-4355
US

V. Phone/Fax

Practice location:
  • Phone: 773-565-3074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036.178094
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.178094
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: