Healthcare Provider Details

I. General information

NPI: 1033240411
Provider Name (Legal Business Name): GENE LEE CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 COLUMBIA AVE
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

1041 KILLARNEY DR
DYER IN
46311-1294
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-6002
  • Fax: 219-836-6003
Mailing address:
  • Phone: 219-322-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: