Healthcare Provider Details

I. General information

NPI: 1366415432
Provider Name (Legal Business Name): SUK JEAN CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GREENLAWN # 106
LANSING MI
48910
US

IV. Provider business mailing address

15302 CLUB COURSE DR
BATH MI
48808
US

V. Phone/Fax

Practice location:
  • Phone: 517-482-2118
  • Fax: 517-482-6280
Mailing address:
  • Phone: 517-641-7160
  • Fax: 517-482-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberSC032703
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: