Healthcare Provider Details

I. General information

NPI: 1215468178
Provider Name (Legal Business Name): LI-WEI CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 CALUMET AVE STE 203
MUNSTER IN
46321-2885
US

IV. Provider business mailing address

9200 CALUMET AVE STE 203
MUNSTER IN
46321-2885
US

V. Phone/Fax

Practice location:
  • Phone: 219-228-4200
  • Fax:
Mailing address:
  • Phone: 219-228-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number35.142274
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: